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

Abstract

Background: A cervical spinal cord injury (CSCI) is a life-changing event resulting in neurological weakness. Acutely, respiratory complications (RC) 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 RC in this population. The incidence of RC in patients with CSCI who receive MI-E is not widely reported. Aims: To report on the incidence of RC, and to evaluate the clinical application of MI-E in patients with acute traumatic CSCI. Methods: This was a retrospective case note review of patients with acute traumatic CSCI admitted to a UK major trauma centre between January 2017 and September 2018. Incidence of RC on admission and fourteen days post-discontinuation of MI-E were recorded, as well as detail relating to MI-E clinical application, where used. Results: 33 patients were included. Overall incidence of RC was 21.1%. There was no difference in rates of RC between those who received prophylactic MI-E and those who did not (p=0.23). There was a significant difference in the clinical application of therapeutic MI-E compared to prophylactic MI-E, with those receiving therapeutic treatment more frequently (p=0.01) and with higher exsufflation pressures (p=0.003). Conclusion: The findings of this review suggest that MI-E provides no additional benefit in prophylactic management of RC following acute traumatic CSCI. However, this result may be confounded by a small sample size. Further incidence reporting of larger samples including those with thoracic injuries is warranted.