How are the pulmonary complications of spinal cord injury (SCI) treated?

Updated: Nov 01, 2018
  • Author: Lawrence S Chin, MD, FACS, FAANS; Chief Editor: Brian H Kopell, MD  more...
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Treatment of pulmonary complications and/or injury in patients with spinal cord injury (SCI) includes supplementary oxygen for all patients and chest tube thoracostomy for those with pneumothorax and/or hemothorax.

The ideal technique for emergent intubation in the setting of spinal cord injury is fiberoptic intubation with cervical spine control. This, however, has not been proven better than orotracheal with in-line immobilization. Furthermore, no definite reports of worsening neurologic injury with properly performed orotracheal intubation and in-line immobilization exist. If the necessary experience or equipment is lacking, blind nasotracheal or oral intubation with in-line immobilization is acceptable.

Indications for intubation in spinal cord injury are acute respiratory failure, decreased level of consciousness (Glasgow score < 9), increased respiratory rate with hypoxia, partial pressure of carbon dioxide (PCO2) greater than 50 mm Hg, and vital capacity less than 10 mL/kg.

In the presence of autonomic disruption from cervical or high thoracic spinal cord injury, intubation may cause severe bradyarrhythmias from unopposed vagal stimulation. Simple oral suctioning can also cause significant bradycardia. Preoxygenation with 100% oxygen may be preventive. Atropine may be required as an adjunct. Topical lidocaine spray can minimize or prevent this reaction.

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