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Neurogenic Respiratory Failure

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Neurological Aspects of Spinal Cord Injury

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Abstract

A high spinal cord injury (SCI) above the fifth cervical level usually results in a severe impairment of the respiratory function. Paralysis of the muscles needed for respiration, foremost the diaphragm muscle, leads to a significant loss of vital capacity with the need of partial or complete mechanical ventilation. Nearly ten percent of all SCI patients need temporary ventilation during initial treatment directly after the impairment. Six percent of this group are in need of permanent artificial ventilation due to unsuccessful weaning attempts.

In industrialised countries, the incidence and the age of ventilated patients have increased dramatically over the last decade. Older patients often have multiple comorbidities, which prolong the time of primary rehabilitation. The diagnostic procedures and individual therapy of neurogenic respiratory dysfunctions are complex and can only be handled adequately by a multidisciplinary team. Life-long medical support for inpatient and out-of-hospital treatment, the correct application of non-invasive and invasive ventilation, proper adaptation of the weaning regime and the setup of long-term ventilation including implantation of an electrical diaphragm stimulator represent clinical challenges.

A long-term follow-up of ventilated patients regarding complications, life expectancy, mortality and survival rates is needed to allow for the definition of valid standards of care and to achieve a high degree of quality of life in this growing patient population.

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  1. BG Trauma Hospital Hamburg, SCI Center, Bergedorfer Straße 10, 21033, Hamburg, Germany

    Sven Hirschfeld & Roland Thietje

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  1. Sven Hirschfeld
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  1. Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany

    Norbert Weidner

  2. Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany

    Rüdiger Rupp

  3. Methodist Rehabilitation Center, University of Mississippi Medical Center, Veterans Administration Medical Center, Jackson, Mississippi, USA

    Keith E. Tansey

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Hirschfeld, S., Thietje, R. (2017). Neurogenic Respiratory Failure. In: Weidner, N., Rupp, R., Tansey, K. (eds) Neurological Aspects of Spinal Cord Injury. Springer, Cham. https://doi.org/10.1007/978-3-319-46293-6_17

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