Mechanical insufflation-exsufflation for the prevention and treatment of respiratory complications in acute cervical spinal cord injury: A retrospective service evaluation

Abstract

Background A cervical spinal cord injury (CSCI) is a life-changing event resulting in neurological weakness. Acutely, respiratory complications are the leading cause of mortality. Mechanical insufflation-exsufflation (MI-E) is used to augment cough and promote airway clearance in the prevention and treatment of respiratory complications in this population. The incidence of respiratory complications in subjects with CSCI who receive MI-E is not widely reported. Objectives To report on the incidence of respiratory complications and to evaluate the clinical application of MI-E in subjects with acute traumatic CSCI. Methods This was a retrospective case note review. Data was collected for subjects with a traumatic CSCI admitted to a U.K. major trauma centre between January 2017 and September 2018. The incidence of respiratory complications on admission and 3 weeks post-admission were collected. Where used, detail relating to MI-E clinical application was recorded. Results 33 subjects were eligible for inclusion. The overall incidence of respiratory complications was 21% (7/33). There was no significant difference in occurrence of respiratory complications between those who received MI-E and those who did not. There was a significant difference in the clinical application of therapeutic MI-E compared to prophylactic MI-E. The ‘number of cycles’ and ‘exhale pressure’ settings were found to be significantly greater in those receiving therapeutic treatment (p = <0.001; p = 0.002 respectively). Reporting of other MI-E parameters and treatment detail was poor. Conclusion Whilst the findings of this review may suggest that MI-E provides no additional benefit in the prevention of respiratory complications following acute traumatic CSCI, firm conclusions cannot be drawn due the small sample and poor treatment detail reporting. Further incidence reporting in a multi-site study, including those with thoracic injuries is warranted.