Study of the effectiveness of bronchial clearance in subjects with upper spinal cord injuries: examination of a rehabilitation programme involving mechanical insufflation and exsufflation

• Published in: Spinal cord Vol. 44; no. 10; pp. 614 - 616
• Main Authors: PILLASTRINI, P, BORDINI, S, BAZZOCCHI, G, BELLONI, G, MENARINI, M
• Format: Journal Article
• Language: English
• Published: London Nature Publishing 01.10.2006; Nature Publishing Group
• Subjects: Adult; Aged; Biological and medical sciences; Case-Control Studies; Cerebrospinal fluid. Meninges. Spinal cord; Cerebrospinal fluid. Spinal cord. Spinal roots. Spinal nerves; Continuous Positive Airway Pressure; Female; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Insufflation - methods; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Neurosurgery; Physical Therapy Modalities; Positive-Pressure Respiration - methods; Pulmonary Ventilation - physiology; Respiratory Function Tests - methods; Respiratory Therapy; Spinal Cord Injuries - rehabilitation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tracheostomy; Traumas. Diseases due to physical agents; Treatment Outcome; Human; Nervous system diseases; mechanical insufflation/exsufflation; Vertebral canal; cervical spinal cord injury; Spinal cord trauma; Central nervous system disease; Rehabilitation; Spinal cord disease; tracheostomy; Cervical spinal cord
• ISSN: 1362-4393; 1476-5624
• DOI: 10.1038/sj.sc.3101870

Randomized controlled trial. To establish whether the use of mechanical insufflation/exsufflation leads to a significant improve in tracheostomy subjects with upper spinal cord injuries (C1-C7), ASIA classification grade A and bronchial hyper secretion the following parameters: forced vital capacity (FVC), forced exspiratory volume on the first second (FEV1), FEV1/FVC, peak exspiratory flow (PEF), arterious pressure of O(2) (Pa O(2)), arterious pressure of CO(2) (Pa CO(2)), pH, saturation of O(2) (Sa O(2)). Spinal Cord Unit, Montecatone Rehabilitation Institute, Imola, Italy. The patients were split into two groups: the experimental group (EG) and the control group (CG). Each patient was given 10 treatments: the EG was given manual respiratory kinesitherapy associated with mechanical insufflation/exsufflation with inhale and exhale pressure between 15 cm H(2)O and 45 cm H(2)O, while the CG was only given manual kinesitherapy. The treatment sessions covered the necessary amount of time in order to achieve sufficient clearance. The study has been approved by the local ethic committee. The patients were informed before being enrolled in that study and gave their written consent. At the end of the treatment associated with the mechanical insufflation/exsufflation, the EG showed a significant increase in FVC, FEV1 and PEF, although it was not possible to compare the latter with the CG. The other parameters were also subject to variations, although not statistically significant. The CG did not show signs of any significant change. The use of mechanical insufflation/exsufflation in subjects with the aforementioned characteristics is shown to be an effective adjunct to manual respiratory kinesitherapy, since it makes it possible to achieve adequate bronco-pulmonary clearance, even removing thick, deep secretions and making it possible to insufflate any areas affected by atelectasis.