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Respiratory complications in the adult patient with chronic spinal cord injury

Author
Eric Garshick, MD, MOH
Section Editors
Michael J Aminoff, MD, DSc
Polly E Parsons, MD
Deputy Editors
Geraldine Finlay, MD
Janet L Wilterdink, MD

INTRODUCTION

The number of people in the United States living with spinal cord injury (SCI) was estimated to be 276,000 persons in 2014 (240,000 to 337,000) [1]. Rates of new injury are estimated to be 54 cases per million [2]. Causes of SCI include trauma (eg, vehicular crashes, falls, gunshot wounds), tumor, vascular disease, demyelinating spinal cord diseases, and spinal stenosis [1,3]. Respiratory failure is common after acute SCI and in persons with chronic SCI who develop respiratory illnesses. Respiratory complications are the most common cause of death [4-7]. The spectrum of pulmonary complications following SCI includes respiratory failure, pneumonia, atelectasis, pulmonary thromboembolism, sleep disorders, dyspnea, and dysphonia.  

This topic reviews the prevention and management of respiratory complications of SCI. The diagnosis and management of acute SCI, including the acute management of respiratory failure, the management of other common complications of SCI, and the changes in respiratory physiology that occur following SCI are discussed separately. (See "Acute traumatic spinal cord injury" and "Chronic complications of spinal cord injury and disease" and "Respiratory physiologic changes following spinal cord injury".)

EPIDEMIOLOGY

Pulmonary complications following SCI are common and contribute to morbidity, including rehospitalization. In a Canadian study assessing hospitalization in the year following discharge, 27.5 percent of persons with SCI were rehospitalized at least once, and 11.5 percent of the hospitalizations were attributed to a respiratory cause [8]. In the US, overall rates of hospitalization 5 to 20 years after injury were approximately 20 to 25 percent, with 8.1 percent attributable to diseases of the respiratory system [9].

Pulmonary complications are most common immediately following acute SCI and decrease in the months to years after SCI. Most studies find that the likelihood of complications depends on the level and completeness of SCI, with a greater risk in persons with higher and neurologically more complete SCI [10,11]. However, in a prospective cohort study of a subset of persons with SCI who had survived at least one year (mean survival 17 years) and were not receiving chronic mechanical ventilation or have a tracheostomy, the level and completeness of SCI were not associated with an increased risk of future respiratory illness, hospitalization for cardiac or pulmonary causes, or decline in pulmonary function [12,13]. Independent risk factors for respiratory illness assessed prospectively include a lower percent predicted forced expiratory volume in one second (FEV1), smoking history, history of chronic obstructive pulmonary disease (COPD), and history of pneumonia or bronchitis since SCI (RR = 2.29; 1.40-3.75) [12-15]. These findings demonstrate the contribution of factors other than level and severity of SCI in determining respiratory health in persons with chronic SCI who are long-term survivors.

Depending on the study, respiratory diseases are the first or second (after circulatory diseases) most common underlying cause of death in the years following SCI, accounting for up to 20 to 30 percent of the mortality that occurs beyond the first year after SCI [15-18]. The mortality risk is highest among those with the most rostral lesions and those requiring long-term mechanical ventilation.

                          

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Literature review current through: Nov 2016. | This topic last updated: Wed Aug 17 00:00:00 GMT 2016.
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