Respiratory management, survival, and quality of life for high-level traumatic tetraplegics.

Although spinal cord injury is devastating and can compromise the respiratory system, particularly when the cervical cord is injured, aggressive use of noninvasive respiratory muscle aids can reduce the otherwise commonly seen complications of pneumonia, bronchial mucous plugging, atelectasis, and respiratory failure. Accessory muscle function can also usually be improved and the muscles then recruited to help maintain adequate alveolar ventilation during the acute spinal cord injury recovery period. Noninvasive assisted ventilation can be successful for patients with compromised lung function during the acute rehabilitation period as well as on a long-term basis. Removal of an indwelling tracheostomy tube results in improved quality of life from many points of view, a decreased number of local tracheostomy complications, a decreased number of serious respiratory infections, an improved ability to communicate, and an increased ability to use the mouth for functions such as operating computers and wheelchairs.