Alternative methods of ventilatory support for the patient with ventilatory failure due to spinal cord injury.

Ventilatory insufficiency and impaired airway secretion clearance are common complications of spinal cord injury (SCI) and can lead to respiratory failure which is the leading cause of death in both the acute and chronic stages. Standard invasive management options such as intubation, tracheostomy and electrophrenic respiration have been reviewed. The review findings are consistent with our clinical experience in that these invasive options appear to entail unacceptably high morbidity and risks of mortality. A number of detailed parameters are suggested for evaluating the respiratory functioning of the individual in order to determine the most acceptable and successful noninvasive systems for both ventilatory support and evacuation of airway secretions. They are physiological substitutes for the action of the inspiratory and expiratory muscles. These techniques are described in detail. We conclude that noninvasive techniques can safely and effectively obviate the need for intubation, tracheostomy and electrophrenic pacemakers in appropriate individuals with SCI.