The withdrawal of tracheostomy and the use of NIV in tetraplegics patients in post-Inensive Care Units
Dr Bénédicte REISSa
a CHU Nantes
The rate of the C1-C4 tetraplegia has tripled in 30 years, in parallel, the mortality rate decreased by 90%. The respiratory etiology remains a leading cause of death in the first year.
In the acute phase, several mechanisms explain the severity of the respiratory disorder: a significant decrease in lung volumes proportional to the neurological level, decreased lung compliance and parietal compliance, vagal hyperactivity and a modification of the diaphragmatic function. The early use of a tracheostomy can reduce the duration of mechanical ventilation and reduce the complications of prolonged intubation. It must be systematically for levels
The incidence of respiratory complications (36% atelectasis, pneumonia 31%) relate to 84% of C1 -C4 tetraplegic patients, 60% for C5-C8 levels. The use of NIV helps prevent and treat respiratory complications in the acute phase due to the achievement of the inspiratory and expiratory function.
Among the different instrumental techniques: air-stacking, hyper-insufflation (pressure relaxant). They allow obtaining a prompt increased inspiratory volume. Their goals: to increase lung compliance, increase recruitment of atelectasics areas, reduce the stiffness of the chest wall.
Mucus plugging increases the work of breathing and promotes atelectasis can lead to pneumonia. Instrumental helps to fight against the mucus plugging : the in-exsufflator cough assist devices that provides a distal drainage of secretions by simulating cough. Its use allows a reduction of the use of fibroaspiration. Its most common settings: 40 cm H2O and blowing -40cm H2O exsufflation.
This respiratory care must be part of a comprehensive rehabilitation program for systemic deficiencies tetraplegic patients.
Keywords : tetraplegic-NIV-tracheostomy