Toki Akiko, Hanayama Kozo, Ishikawa Yuka
Department of Rehabilitation, Kansai Rosai Hospital , Amagasaki, Hyogo , Japan.
Top Spinal Cord Inj Rehabil. 2012 Spring;18(2):193-6. doi: 10.1310/sci1802-193.
To report conversion from tracheostomy (TIV) to noninvasive intermittent positive pressure ventilation (NIV) for a continuously ventilator-dependent patient with high-level spinal cord injury (SCI) with no measurable vital capacity (VC = 0 mL) to resolve tracheostomy-associated complications.
A case report of a 38-year-old female in a chronic care facility in Japan with a 10-year history of ventilator-dependent tetraplegia (C1 ASIA-A) presented for increasing difficulty vocalizing. She had been using a fenestrated cuffed tracheostomy tube to produce speech with the cuff deflated. Speech was increasingly hypophonic, because of tracheostoma enlargement, tube migration, and tracheal granulation.
The NIV was provided via nasal and oral interfaces, the ostomy was surgically closed, and vocalization resumed. Airway secretions were expulsed using manually assisted coughing. The patient returned to the community.
Conversion to NIV should be considered for ventilator-dependent patients with SCI who have adequate bulbar-innervated muscle function to permit effective speech and assisted coughing.
报告一例持续依赖呼吸机的高位脊髓损伤（SCI）患者，其肺活量无法测量（VC = 0 mL），为解决气管造口相关并发症，从气管造口通气（TIV）转换为无创间歇正压通气（NIV）的情况。
报告一名38岁日本女性慢性护理机构患者的病例，该患者有10年依赖呼吸机的四肢瘫痪病史（C1 ASIA - A级），因发声困难加重前来就诊。她一直使用带孔的带气囊气管造口管，在气囊放气时发声。由于气管造口扩大、导管移位和气管肉芽形成，发声越来越微弱。
通过鼻罩和口鼻面罩提供NIV，手术封闭造口，发声恢复。通过手动辅助咳嗽排出气道分泌物。患者重返社区。
对于依赖呼吸机且延髓支配肌肉功能足够以实现有效发声和辅助咳嗽的SCI患者，应考虑转换为NIV。
