Abstract
Alvisi V, Marangoni E, Zannoli S, Uneddu M, Uggento R, Farabegoli L, Ragazzi R, Milic-Emili
J, Belloni GP, Alvisi R, Volta CA. Pulmonary function and expiratory flow limitation
in acute cervical spinal cord injury.
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 (P0.1); (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 P0.1 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.
Key Words
List of Abbreviations:
ATS (American Thoracic Society), ERV (expiratory reserve volume), FEV1 (forced expiratory volume in 1 second), FRC (functional residual capacity), FVC (forced vital capacity), IC (inspiratory capacity), MEP (maximal static expiratory pressure), MIP (maximal static inspiratory pressure), NEP (negative expiratory pressure), P0.1 (mouth occlusion pressure developed 0.1 seconds after occluded inspiration at functional residual capacity), PEEPe (extrinsic positive end-expiratory pressure), RV (residual volume), SCI (spinal cord injury), TEFL (tidal expiratory flow limitation), V (volume), V' (flow), VT (tidal volume), VC (vital capacity)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 30, 2012
Footnotes
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
In-press corrected proof published online on May 30, 2012, at www.archives-pmr.org.
Identification
Copyright
© 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
