Clearing away pulmonary secretions


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Geplaatst door: Han Franssen op 2016-01-30 10:49:44

1Department of Respiratory Care Services, Santa Clara Valley Medical Center, San Jose, CaliforniaDepartment of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California
PRUITT, BILL RRT, AE-C, CPFT, MBA; JACOBS, MICHAEL RN, CCRN, CEN, MSNSpecialized Respiratory Management for Acute Cervical Spinal Cord Injury: A Retrospective Analysis
Volume 18, Number 4 / Fall 2012 - Respiratory Care and Management in SCI
283-290
10.1310/sci1804-283

Abstract
Excess or retained pulmonary secretions impair ventilation, invite infection, and may threaten survival. Find out who's at greatest risk and how to keep airways clear.
Background: In individuals with cervical spinal cord injury (SCI), respiratory complications arise within hours to days of injury. Paralysis of the respiratory muscles predisposes the patient toward respiratory failure. Respiratory complications after cervical SCI include hypoventilation, hypercapnea, reduction in surfactant production, mucus plugging, atelectasis, and pneumonia. Ultimately, the patient must use increased work to breathe, which results in respiratory fatigue and may eventually require intubation for mechanical ventilation. Without specialized respiratory management for individuals with tetraplegia, recurrent pneumonias, bronchoscopies, and difficulty in maintaining a stable respiratory status will persist. Objective: This retrospective analysis examined the effectiveness of specialized respiratory management utilized in a regional SCI center. Methods: Individuals with C1-C4 SCI (N = 24) were the focus of this study as these neurological levels present with the most complicated respiratory status. Results: All of the study patients’ respiratory status improved with the specialized respiratory management administered in the SCI specialty unit. For a majority of these patients, respiratory improvements were noted within 1 week of admission to our SCI unit. Conclusion: Utilization of high tidal volume ventilation, high frequency percussive ventilation, and mechanical insufflation-exsufflation have demonstrated efficacy in stabilizing the respiratory status of these individuals. Optimizing respiratory status enables the patients to participate in rehabilitation therapies, allows for the opportunity to vocalize, and results in fewer days on mechanical ventilation for patients who are weanable.


Nederlands:

Achtergrond: bij patienten met CS letsel komen respiratoire complicaties uren tot dagen na letsel voor. Respiratoire complicaties na een CS letsel kunnen zijn; hypoventilatie, hypercapnie, afname surfactant productie, sputum proppen, atelectase en pneumonieen. Uiteindelijk treedt er respiratoire insufficientie op en moet de patiënt geintubeerd en mechanisch beademd worden.
Doel: deze retrospectieve analyse onderzoekt de effectiviteit van gespecialiseerde respoiratoir management uitgevoerd in een regionaal CS center.
Methoden: individueen met C1-C4 CS (N=24) waren het onderwerp van de studie, aangezien letsels op deze hoogte van de ruggenwervel zich het meest presenteren met gecompliceerde respiratoire status.
Resultaten: gebruik van hoog tidal volume ventilatie, hoge frequentie percussie ventilatie en mechanische inspiratie-expiratie laten effectiviteit zien in het stabilizeren van de respiratoire status van deze individuen. Het optimaliseren van de respiratoire status maakt het voor de patiënt mogelijk om te participeren in revalidatie therapieen, te vocaliseren en laat in minder aantal dagen aan mechanische ventilatie meer resultaat zien voor patiënten die geweaned kunnen worden.