Respiratory Care of Spinal Cord Injury Patient: Survey

Abstract

Background: Respiratory complications are one of the leading causes of death following spinal cord injury (SCI). Still, there is a lack of clear evidence on how to properly treat SCI patients with deficits related to a trauma injury. Therefore, the goal of the survey is to gain a better understanding of the respiratory care provided to SCI patients.

Methods: The Institutional Review Board (IRB) of the University of Baltimore approved the distribution of a survey to respiratory therapists. The survey was disseminated through various channels, including social media platforms like LinkedIn and Facebook and professional networks such as the American Association for Respiratory Care (AARC) Connect.

Results: We collected responses from 90 respiratory therapists in 33 states, most working in level 1 trauma centers. According to the survey results, most respondents (75%) are not ventilating with a tidal volume greater than 8 mL/kg/PBW, as discussed in the literature as a ventilating strategy for spinal cord injury (SCI) patients. 48% reported using VC-AC as the initial mode, and over 20% mentioned using dual-targeted modes. 66% set the initial PEEP was set at 5-6 cm H₂O but varied from 0 to 10 cm H₂O.67% of the respondents stated that they have a secretion clearance protocol, and 53% used it proactively versus as symptoms developed. One respondent stated that they are not using any secretion modalities. The modalities used vary, but the most used devices included cough assist, intrapulmonary percussive ventilation (IPV), CPT, and flutter valves. The use of bronchodilators was reported by 35% as a standard of care, while 64% of the respondents based their use on indications.

Conclusions: We see variability in the respiratory care provided to SCI patients in acute care. The results highlight the need for further research to identify best practices and develop standardized clinical practice guidelines for respiratory therapists to follow for optimization of care. Future randomized control studies could focus on the effectiveness of different ventilation modes, the impact of proactive versus reactive use of secretion clearance protocols, and the role of individualized treatment approaches in improving patient outcomes. These efforts, led by respiratory therapists, could bridge the gap between recommended and actual clinical practices, ultimately improving the quality of care for SCI patients.