Atelectasis and mucus plugging in spinal cord injury: case report and therapeutic approaches.

INTRODUCTION

The leading causes of morbidity and mortality in the spinal cord injury (SCI) population are airway mucus plugging and atelectasis.

OBJECTIVE

To illustrate the risks of pulmonary disease in individuals with SCI, and present effective therapeutic interventions.

DESIGN

Case study of a 60-year-old veteran with T7 ASIA A spinal cord injury, who presented with a complete collapse of the left lung.

FINDINGS

This patient developed fever, sepsis, and acute renal failure following colonoscopy. Following nephrostomy to remove a calculus, chest x-ray revealed complete collapse of the left lung. Despite the severe degree of atelectasis, he exhibited only mild respiratory distress. Aggressive treatment including chest physiotherapy techniques and pharmacologic intervention (acetylcysteine; bronchodilators) resulted in significant radiographic and clinical improvement. After his return to the SCI unit, his respiratory function was monitored, and assisted cough techniques were continued.

CONCLUSIONS

Individuals with SCI have high risk of pulmonary complications. Because of neurological deficits, the usual signs and symptoms may not be apparent. Optimal management depends upon awareness of the risks, and a thorough understanding of the pathophysiology of mucus plugging and atelectasis and the alterations in pulmonary mechanics (dependent on level of injury).