Noninvasive respiratory management of high level spinal cord injury

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This article describes noninvasive acute and long-term management of the respiratory muscle paralysis of high spinal cord injury (SCI). This includes full-setting, continuous ventilatory support by noninvasive intermittent positive pressure ventilation (NIV) to support inspiratory muscles and mechanically assisted coughing (MAC) to support inspiratory and expiratory muscles. The NIV and MAC can also be used to extubate or decannulate 'unweanable' patients with SCI, to prevent intercurrent respiratory tract infections from developing into pneumonia and acute respiratory failure (ARF), and to eliminate tracheostomy and resort to costly electrophrenic/diaphragm pacing (EPP/DP) for most ventilator users, while permitting glossopharyngeal breathing (GPB) for security in the event of ventilator failure.

Original languageEnglish (US)
Pages (from-to)72-80
Number of pages9
JournalJournal of Spinal Cord Medicine
Issue number2
StatePublished - Mar 2012

All Science Journal Classification (ASJC) codes

  • Clinical Neurology


  • Assisted cough
  • Diaphragm pacing
  • Electrophrenic pacing
  • Glossopharyngeal breathing
  • Mechanical insufflation-exsufflation
  • Noninvasive mechanical ventilation
  • Respiratory therapy
  • Spinal cord injuries
  • Tetraplegia


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