Traumatic Spinal Cord Injury: Pulmonary Physiologic Principles and Management.

In the United States, approximately 17,500 cases of traumatic spinal cord injury (SCI) occur each year, with an estimated 245,000 to 345,000 individuals living with chronic SCI. Acute management of respiratory dysfunction has resulted in improvement in early survival, but life expectancy remains less than that of the general population, and pulmonary complications are a leading cause of mortality. The global changes in pulmonary function, underlying pathophysiology, and the management options to improve respiratory muscle weakness and pulmonary clearance in persons with SCI are discussed.

Bronchodilator effects of ipratropium bromide and albuterol sulfate among subjects with tetraplegia.

Objective: In addition to lung volume restriction, persons with chronic tetraplegia demonstrate obstructive airway physiology evinced by pharmacologically-induced bronchodilation. We previously found independent evidence that anticholinergic agents (ipratropium bromide; IB) and beta-2 adrenergic agonists (albuterol sulfate; AS) were associated with significant bronchodilation in subjects with tetraplegia as determined via spirometry or body plethysmography. Direct comparison of these two classes of agents has received little attention.

Biomarkers of inflammation in persons with chronic tetraplegia.

In addition to lung volume restriction, individuals with chronic tetraplegia exhibit reduced airway caliber and bronchodilator responsiveness similar to persons with asthma. In asthma, airflow obstruction is closely linked to airway inflammation. Conversely, little is known regarding the airway inflammatory response in tetraplegia.

Greatly increased prevalence of esophageal dysmotility observed in persons with spinal cord injury.

The effects of spinal cord injury (SCI) on esophageal motility are largely unknown. Furthermore, due to the complete or partial loss of sensory innervation to the upper gastrointestinal tract, a symptom-based diagnosis of esophageal dysmotility is problematic in the SCI population. To determine the prevalence and characterize the type of motility disorders observed in persons with chronic SCI compared with that of able-bodied (AB) controls based on esophageal pressure topography isometrics acquired by high-resolution manometry and categorized by application of the Chicago Classification.

A center's experience: pulmonary function in spinal cord injury.

Traumatic spinal cord injury (SCI) is associated with significant psychological and physical challenges. A multidisciplinary approach to management is essential to ensure recovery during the acute phase, and comprehensive rehabilitative strategies are necessary to foster independence and quality of life throughout the chronic phase of injury. Complications that beset these individuals are often a unique consequence of SCI, and knowledge of the effects of SCI upon organ systems is essential for appropriate management.