Respiratory issues following a spinal cord injury

Respiratory Issues Following a Spinal Cord Injury

A serious injury to the spine will impact the body in numerous ways in addition to reduced mobility. Respiratory issues following a spinal cord injury may occur, depending on the level of the injury and severity of the damage.

During the individual’s recovery process, various respiratory issues may need to be managed and once again this will depend on the severity of the injury and location in which the damage was sustained.

Here we take a closer look at the main respiratory issues that can arise following a spinal cord injury and how they can be effectively managed.

How the Respiratory System Typically Works

The main organs used during the process of respiration are the lungs. The lungs take oxygen from the outside world and pull it into the body to the blood vessels where it is used for energy. They also expel carbon dioxide as we breath out. The lungs contain small structures called alveoli that handle the exchange of gases.

Human respiratory system infographic

Breathing is controlled by the diaphragm, a layer of muscle below the lungs that flattens out to draw air in and then relaxes to expel it. A normal adult will take 12 to 20 breaths a minute.

The diaphragm is controlled by the phrenic nerve and damage to this nerve can often affect the process of breathing in those who have sustained a serious spinal cord injury (SCI).

How a Spinal Cord Injury Can Affect Respiratory Health

Damage to the spinal cord above the level of the C3 vertebrae can impair the phrenic nerve and cause issues in controlling the diaphragm and consequently breathing. In many cases, an individual who has sustained this type of injury will need a ventilator to assist with drawing oxygen into the lungs as well as exhaling carbon dioxide. Essentially these machines help the lungs to function properly, if they are unable to work effectively on their own.

Problems can still occur, however, when damage is between C3 and C5 as other muscles such as the intercostals are involved in the breathing process. While the diaphragm is working, the other muscles are impaired which means breathing can be difficult if not impossible.

For example, an individual with mid-thoracic damage may be unable to force a cough or breath forcibly. This can cause a range of respiratory issues and problems with congestion that need to be managed.

Preventing Respiratory Issues Following a Spinal Cord Injury

There are a number of different ways to manage respiratory issues following a spinal cord injury.
These include:

  • Maintaining a good posture and keeping as mobile as possible so that congestion doesn’t build up.
  • An assist cough can allow an individual who cannot cough on their own to clear their airway of mucus.
  • An abdominal binder may provide more help to support the abdominal and intercostal muscles.
  • Individuals should maintain a healthy diet and drink plenty of water.
  • Exercise, however, limited because of the injury, is important for improving circulation and can also aid breathing.
  • Needless to say, stopping smoking is not only important for overall health but can improve lung function.
  • Health problems such as pneumonia and influenza can all affect lung strength so getting vaccinated is important for individuals with a spinal cord injury.

Spinal Cord Injury Ventilators

Medical ventilator used in hospital
Hospital grade ventilator

A spinal cord injury ventilator may be required for those who have certain types of SCI. This is usually employed when the individual has damage above the C3 level and needs assistance in being able to breathe.

Those with damage between C3 and C4 may have to initially use a ventilator but also might be weaned off it with good management and enough time. There are two different types of ventilator:

  • A negative pressure ventilator is used to produce a vacuum outside the chest which the lungs then expand to fill, drawing in breath.
  • Positive pressure ventilators, on the other hand, operate by physically blowing air into the lungs via a tube that fits into the throat area.
  • Ventilators are able to deliver a range of different breaths and have volume and pressure controls.

Some people can stop using a ventilator and may instead use a non-invasive breathing system, others may only need it when they go to bed at night. Some will need to use a ventilator all the time.

Sleep can be particularly problematic for those with spinal cord injuries and conditions such as sleep apnea are not unusual, though employing a ventilator can help.

A Major Concern

Respiratory health following a spinal cord injury can be a major concern and management can vary depending on the types of issues faced and which area of the spine was damaged. In severe cases, a ventilator will be required to maintain breathing for the individual but others can wean themselves off such devices and breath unassisted.