Article

OBJECTIVE: To identify the nature of the changes of respiratory mechanics in
patients with middle cervical spinal cord injury (SCI) and their correlation with posture.
DESIGN: Clinical trial. SETTING: Acute SCI unit.
PARTICIPANTS: Patients
with SCI (N=34) at C4-5 level studied within 6 months of injury. INTERVENTIONS:
Patients were assessed by the negative expiratory pressure test, maximal static
respiratory pressure test, and standard spirometry. MAIN OUTCOME MEASURES: The
following respiratory variables were recorded in both the semirecumbent and
supine positions: (1) tidal expiratory flow limitation (TEFL); (2) airway
resistances; (3) mouth occlusion pressure developed 0.1 seconds after occluded
inspiration at functional residual capacity (P(0.1)); (4) maximal static
inspiratory pressure (MIP) and maximal static expiratory pressure (MEP); and (5)
spirometric data. RESULTS: TEFL was detected in 32% of the patients in the supine
position and in 9% in the semirecumbent position. Airway resistances and P(0.1)
were much higher compared with normative values, while MIP and MEP were markedly
reduced. The ratio of forced expiratory volume in 1 second to forced vital
capacity was less than 70%, while the other spirometric data were reduced up to
30% of predicted values. CONCLUSIONS: Patients with middle cervical SCI can
develop TEFL. The presence of TEFL, associated with increased airway resistance,
could increase the work of breathing in the presence of a reduced capacity of the
respiratory muscles to respond to the increased load.
The semirecumbent position
and the use of continuous positive airway pressure can be helpful to (1) reduce
the extent of TEFL and avoid the opening/closure of the small airways; (2)
decrease airway resistance; and (3) maintain the expiratory flow as high as
possible, which aids in the removal of secretions.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS