The care of patients with high-level SCI is made more
complex by the need for mechanical ventilation. Although
most patients are ventilated via tracheostomy tube, Bach
and colleagues found that patients with SCI and other
patients with neuromuscular disorders can be successfully
decannulated and treated with noninvasive ventilation.
108 –111 Patient-ventilator interfaces for such ventilation
are reviewed elsewhere in this issue of RESPIRATORY
CARE.112 Patients seem to prefer noninvasive ventilation
for reasons of appearance, comfort, swallowing, and
speech.113 Other advantages appear to be reduction in secretions
because the tracheostomy tube is not present to
irritate the trachea, fewer hospitalizations, and lower cost
of care.114 More attention should be paid to the option of
noninvasive ventilation, especially given the considerable
literature supporting this approach.
Mechanically ventilated patients typically prefer large
VT. The reason is not established, but it may be related to relief of the dyspnea that is associated with small tidal
breaths.65 Large breaths also have the benefit of preventing
small-airway narrowing or closure by stretching airway
smooth muscle, and by reducing surface tension by
expanding the surface area of pulmonary surfactant. Breath
sizes as large as 1.0 L (often with PEEP of 5 cm H2O) are
common and do not cause ventilator-associated lung damage
in the absence of acute lung injury from other causes.
The common result is low PaCO2
, but there are not any
known deleterious long-term consequences of this
The care of patients with high-level SCI is made more
complex by the need for mechanical ventilation. Although
most patients are ventilated via tracheostomy tube, Bach
and colleagues found that patients with SCI and other
patients with neuromuscular disorders can be successfully
decannulated and treated with noninvasive ventilation.
108 –111 Patient-ventilator interfaces for such ventilation
are reviewed elsewhere in this issue of RESPIRATORY
CARE.112 Patients seem to prefer noninvasive ventilation
for reasons of appearance, comfort, swallowing, and
speech.113 Other advantages appear to be reduction in secretions
because the tracheostomy tube is not present to
irritate the trachea, fewer hospitalizations, and lower cost
of care.114 More attention should be paid to the option of
noninvasive ventilation, especially given the considerable
literature supporting this approach.
Mechanically ventilated patients typically prefer large
VT. The reason is not established, but it may be related to relief of the dyspnea that is associated with small tidal
breaths.65 Large breaths also have the benefit of preventing
small-airway narrowing or closure by stretching airway
smooth muscle, and by reducing surface tension by
expanding the surface area of pulmonary surfactant. Breath
sizes as large as 1.0 L (often with PEEP of 5 cm H2O) are
common and do not cause ventilator-associated lung damage
in the absence of acute lung injury from other causes.
The common result is low PaCO2
, but there are not any
known deleterious long-term consequences of this
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