Respiratory Options for Ventilator Dependent Quadriplegics

Content via Christopher & Dana Reeve Foundation
Christopher & Dana Reeve Foundation

Individuals with paralysis above the C5 level often require mechanical ventilation in order to breathe. 

Factors that affect breathing function

Regardless of the nature of the paralysis, whether it occurs from injury or from disease, the two factors that most greatly affect breathing function are smoking and aging.  “If a person smoked previously to paralysis or after paralysis, breathing function will be sharply reduced,” shares Nurse Linda. Even just being in close proximity to people who smoke can have a negative effect on breathing. For example, caregivers who step outside to smoke will still carry fumes on their clothing and skin, and those fumes can directly impact respiration.

Additionally, the aging process naturally affects respiration in everyone, but is especially noticeable for those with paralysis.

“Carrying too much weight around the neck and chest can lead to breathing difficulty, so maintaining weight and moving our bodies to gain flexibility will help maintain our function as we age.”

Ways breathing function can be maintained or increased in high-level quads

  • Exercise: This includes respiratory muscle training (aided by respiratory therapists); range of motion in the upper extremities; use of the cough assist and sigh function on ventilators; and proper positioning and seating.
  • Medications: Consider talking to your doctor about adding a medication to help increase respiratory functions. These medications include Theophylline, expectorants (which helps to clear mucus), and medications that help reduce spasticity.
  • Diaphragm pacemaker: This is a technique where a Functional Electrical Stimulation (FES) devise is attached to the phrenic nerve, and allows the individual to breathe without mechanical ventilation. Not all high-level quads are candidates however, so testing must be done prior to surgery.
  • Non-invasive ventilation via the mouth or nose: “These mechanisms for ventilation can include continuous positive airway pressure (CPAP) … and Bilevel positive airway pressure (BiPAP)” writes Nurse Linda. The choice for which system to utilize is based on the individual’s needs.

It is important to remember that any time a change is made in breathing technique or equipment, there is risk involved, and there is also a necessary period of adjustment.

“Not everyone will be able to eliminate the traditional mechanical ventilation if you depend on that system for respiratory support, but as this science is advancing, more alternative equipment will be developed as well as improvements to the current systems.”

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