Journal of Rehabilitation Research & Development (JRRD)

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Volume 47 Number 3, 2010
   Pages 261 — 272

Abstract — Trendelenburg chest optimization prolongs spontaneous breathing trials in ventilator-dependent patients with low cervical spinal cord injury

Charles J. Gutierrez, PhD, RRT, FAARC;1* Cathy Stevens, RRT;1 John Merritt, MD, FACP;2 Cecille Pope, MD;2 Mihaela Tanasescu, MD, ScD;3 Glenn Curtiss, PhD4

1Neurorespiratory Care Program, Department of Respiratory Care & Diagnostic Services, and 2Spinal Cord Injury/Disorders Service, Bilirakis Spinal Cord Injury Center of Excellence (SCICoE), James A. Haley Veterans Hospital, Tampa, FL; 3Touro University International, College of Health Sciences, Cypress, CA; 4Department of Neuropsychology, Bilirakis SCICoE, James A. Haley Veterans Hospital, Tampa, FL

Abstract — Chest optimization, an evidence-based protocol-guided multimodal chest physiotherapy consisting of body positioning, sputum mobilization, bronchodilation, and lung hyperinflation, may be routinely administered to ventilator-dependent patients with low cervical spinal cord injury (CSCI) for improving pulmonary functional outcomes that facilitate weaning from mechanical ventilation. We undertook this study to determine whether position-specific chest optimization was associated with changes in spontaneous breathing trial (SBT) duration. Cardiac output (CO), alveolar minute volume (MValv), carbon dioxide elimination (VCO2), and static chest compliance (Cst) were measured during chest optimization; then MValv and rapid shallow breathing index (RSBI) were measured during SBT. Study participants (N = 12) were clinically stable ventilator-dependent patients with low CSCI. Trendelenburg chest optimization (TCO) was associated with significant increases in SBT (p < 0.001), CO (p < 0.001), MValv (p < 0.003), VCO2 (p < 0.001), and Cst (p < 0.002). SBT following TCO was associated with significant increases in MValv (p < 0.03) and RSBI (p < 0.002). These preliminary findings suggest the importance of proper recumbent body positioning during evidence-based, protocol-guided multimodal chest physiotherapy for ventilator-dependent patients with low CSCI.

Key words: alveolar minute volume, body positioning, bronchodilation, carbon dioxide elimination, cardiac output, cervical spinal cord injury, chest optimization, chest physiotherapy, evidence-based, lung hyperinflation, multimodal, noninvasive cardiac output monitoring, rapid shallow breathing index, rehabilitation, spontaneous breathing trial, sputum mobilization, static chest compliance, supine, tetraplegia, Trendelenburg.


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Last Reviewed or Updated  Friday, April 30, 2010 9:44 AM