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Vol. 40 No. 5, September/Ocober 2003, Supplement 2
Pages 99 — 110

Using an evidence-based protocol to guide rehabilitation and weaning of ventilator-dependent cervical spinal cord injury patients
Charles J. Gutierrez, MS, RRT; Jeffrey Harrow, MD, PhD; Fred Haines, RRT
Department of Respiratory Care and Diagnostic Services, Spinal Cord Injury/Disorder Service, Spinal Cord Injury
Center, James A. Haley Veterans Hospital, Tampa, FL
Abstract — An evidence-based clinical protocol was developed to improve ventilatory muscle strength and endurance of ventilator-dependent cervical spinal cord injury (SCI) patients. The goal was to help these patients discontinue mechanical ventilation. The protocol, based on findings from other studies in the literature, consisted of pretraining optimization, as well as progressive resistance and endurance training. Following the protocol, mean maximal inspiratory pressure for low tetraplegic patients improved 75 percent, mean maximal expiratory pressure improved 71 percent, mean vital capacity increased 59 percent, mean on-vent endurance time increased 91.6 percent, and mean off-vent breathing time increased 76.7 percent. Both high and low tetraplegic patients achieved gains in inspiratory and expiratory muscle strength, vital capacity, on-vent endurance, and off-vent breathing times. High tetraplegic patients improved their ability to spontaneously ventilate for short periods in case of accidental disconnection from the ventilator, while low tetraplegic patients were able to discontinue mechanical ventilation, which was the desired clinical outcome for this preliminary study.
Key words: endurance, evidence-based, mechanical ventilation, protocol resistance, tetraplegia.

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