Pulmonary Function and Expiratory Flow Limitation in Acute Cervical Spinal Cord Injury

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• 作者：Valentina Alvisi ; MD^a ; Elisabetta Marangoni ; MD^a ; Silvia Zannoli ; MD^a ; Mariella Uneddu ; MD^b ; Riccardo Uggento ; MD^b ; Lucia Farabegoli ; MD^a ; Riccardo Ragazzi ; MD^a ; Joseph Milic-Emili ; MD^c ; Gian P. Belloni ; MD^b ; Raffaele Alvisi ; MD^a ; Carlo A. Volta ; MD^a ; ^{vlc@unife.it" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Quadriplegia ; Rehabilitation ; Respiratory mechanics ; Respiratory muscles ; Spinal cord injuries
• 刊名：Archives of Physical Medicine and Rehabilitation
• 出版年：2012
• 出版时间：November 2012
• 年：2012
• 卷：93
• 期：11
• 页码：1950-1956
• 全文大小：419 K

文摘

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 (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.