Chest

Chest

Volume 127, Issue 2, February 2005, Pages 658-661
Journal home page for Chest

Selected Reports
Effect of Acute Aminophylline Administration on Diaphragm Function in High Cervical Tetraplegia: A Case Report

https://doi.org/10.1378/chest.127.2.658Get rights and content

Theophylline has been shown to have beneficial effects on phrenic nerve and diaphragm activation. This case report involves a C5-C6 chronic tetraplegic patient with acute respiratory failure and ventilator dependence. IV aminophylline was administered in increasing doses (2 mg/kg, 4 mg/kg, and 6 mg/kg) over the course of 1 day. Diaphragm surface electromyography (sEMG), measures of respiration (tidal volume, minute ventilation, and frequency), and serum theophylline levels were captured. Diaphragm sEMG activity increased by a maximum of 50% at therapeutic levels. The rapid shallow breathing index dropped from 112 to 86. The subject was successfully weaned from ventilatory support. We conclude that administration of aminophylline facilitated weaning from ventilatory support in this tetraplegic patient.

Section snippets

Case Report

A 54-year-old, African-American man with a functionally complete C5-C6 spinal cord injury from a gunshot wound received 30 years prior to hospital admission presented to an urban medical center ICU. His neurologic examination indicated a C5 injury on the right side and C6 injury on the left side. Bacterial pneumonia and septicemia were found, and respiratory failure developed subsequent to hospital admission. The patient was placed on mechanical ventilation and was aggressively treated with

Experimental Protocol

The following protocol was carried out in the course of 1 day. Following informed consent, baseline measurements of respiration and surface electromyography (sEMG) signals (Viking IV; Viasys Healthcare; Madison, WI) were obtained. Rectified and moving-time averaged sEMG were measured from the sixth, seventh, and eighth intercostal spaces for eight consecutive spontaneous breaths while the patient was receiving continuous positive airway pressure, 5 cm H2O with no pressure support, through the

Results

Diaphragm sEMG activity (rectified/moving-averaged peak to baseline) increased by a maximum of 50% on the more-affected right side (C5 injury) and 16.9% on the left side (C6 injury) at a dose of 4 mg/kg and a corresponding serum level of 12.4 μg/mL (Table 1). Additionally, the RSBI dropped from a baseline of 112 to 86 at a dose of 6 mg/kg (Table 1, Fig 1). At serum levels greater than the clinically therapeutic range for aminophylline (10 to 20 μg/mL), extinction of the positive effects of

Discussion

This case report demonstrates a clinically significant improvement in diaphragm sEMG activity, RSBI, and ability to maintain spontaneous respiratory function after the administration of aminophylline. Diaphragm sEMGs in this case were obtained as a trending tool for gross diaphragm activation. The outcome measures studied responded to treatment in a dose-related fashion (except RSBI, see below), improving with increasing serum theophylline levels and then decreasing when a theophylline serum

Conclusion

We conclude that administration of aminophylline was an effective therapy for facilitating weaning from ventilatory support in this tetraplegic patient. Additional controlled studies are needed on more patients to confirm this conclusion.

References (17)

There are more references available in the full text version of this article.

Cited by (0)

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: [email protected]).

This work was done at Harper University Hospital, Detroit, MI. This work was funded by National Institutes of Health grant HD31550, and a grant from the State of Michigan.

View full text
Copyright © 2005 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.