Mechanism for Respiratory Insufficiency After Cervical Cord Injury

Abstract

Article1 September 1964Mechanism for Respiratory Insufficiency After Cervical Cord InjuryA Source of Alveolar HypoventilationEDWARD H. BERGOFSKY, M.D.EDWARD H. BERGOFSKY, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-61-3-435 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAcute respiratory failure is commonly observed immediately after injury to the cervical portion of the spinal cord in man. In such patients, clinical scrutiny often demonstrates normal or enhanced excursions of the abdomen with paradoxical inspiratory retraction of the rib cage. These observations are in accord with clinical evaluation, which reveals a normally moving diaphragm and a flaccid paralysis of the muscles of the trunk and extremities. As a general rule, the acute postinjury flaccid paralysis of the muscles of the rib cage and trunk passes into a state of spastic paralysis and the paradoxical motion of the rib cage...References1. BOSHES B: Trauma to the spinal cord, in Clinical Neurology. Edited by BAKER, A. B., Harper Bros, New York, 1962. Google Scholar2. HEMINGWAYBORSHOBBY AERP: An investigation of the pulmonary function of paraplegics. J. Clin. Invest. 37: 773, 1958. CrossrefMedlineGoogle Scholar3. STONEKELTZ DJH: The effect of respiratory muscle dysfunction on pulmonary function: studies in patients with spinal cord injuries. Amer. Rev. Resp. Dis. 88: 621, 1963. MedlineGoogle Scholar4. CUNNINGHAMGUTTMANWHITTERIDGEWYNDHAM DJLDCH: Cardiovascular responses to bladder distensions in paraplegic patients. J. Physiol. 121: 581, 1953. CrossrefMedlineGoogle Scholar5. BALDWINCOURNANDRICHARDS EDADW: Pulmonary insufficiency. 1. Physiological classification, clinical methods of analysis, standard values in normal subjects. Medicine 27: 243, 1948. CrossrefMedlineGoogle Scholar6. RILEYCOURNANDDONALD RLAKW: Analysis of factors affecting the concentration of oxygen and carbon dioxide in gas and blood of lungs. II. Methods. J. Appl. Physiol. 4: 102, 1951. CrossrefMedlineGoogle Scholar7. SCHOLANDER PF: Analyzer for accurate estimation of respiratory gases in one-half cubic centimeter samples. J. Biol. Chem. 167: 235, 1947. CrossrefMedlineGoogle Scholar8. VAN SLYKENEILL DDJM: The determination of gases in blood and other solutions by vacuum extraction and manometric measurement. J. Biol. Chem. 61: 523, 1924. CrossrefGoogle Scholar9. VAN SLYKESENDROY DDJ: Line charts for graphic calculations by Henderson-Hasselbalch equation and for calculating plasma CO2 content from whole blood content. J. Biol. Chem. 79: 781, 1928. CrossrefGoogle Scholar10. CLARKWOLFGRANGERTAYLOR LCRDZ: Continuous recording of blood O2 tensions by polarography. J. Appl. Physiol. 6: 189, 1953. CrossrefMedlineGoogle Scholar11. FORSTERCOHNBRISCOEBLAKEMORERILEY REJEWAWSRL: A modification of the Krogh carbon monoxide breath holding technic for estimating the diffusing capacity of the lung. A comparison with three other methods. J. Clin. Invest. 34: 1417, 1955. CrossrefMedlineGoogle Scholar12. OTISFENNRAHN ABWOH: Mechanics of breathing in man. J. Appl. Physiol. 2: 592, 1950. CrossrefMedlineGoogle Scholar13. RAHNOTISCHADWICKFENN HABLEWO: The pressure-volume diagram of the thorax and lung. Amer. J. Physiol. 146: 161, 1946. CrossrefMedlineGoogle Scholar14. FRYSTEADEBERTLUBINWELLS DLWWRVRIHS: The measurement of intraesophageal pressure and its relationship to intrathoracic pressure. J. Lab. Clin. Med. 40: 664, 1952. MedlineGoogle Scholar15. BERGOFSKY EH: Relative contributions of the rib cage and diaphragm to ventilation in man. J. Appl. Physiol. 19: 561, 1964. CrossrefMedlineGoogle Scholar16. MEADWHITTENBERGER JJL: Physical properties of human lungs measured during spontaneous respiration. J. Appl. Physiol. 5: 779, 1953. CrossrefGoogle Scholar17. ALEXANDERWESTWOODRICHARDS JKJRJADW: Analysis of respiratory response to carbon dioxide inhalation in varying clinical states of hypercapnia, anoxia, and acid-base derangement. J. Clin. Invest. 34: 511, 1955. CrossrefMedlineGoogle Scholar18. MCILROYMARSHALLCHRISTIE MBRRV: The work of breathing in normal subjects. Clin. Sci. 13: 127, 1953. Google Scholar19. FENN WO: Mechanics of respiration. Amer. J. Med. 10: 77, 1951. CrossrefMedlineGoogle Scholar20. BERGOFSKYTURINOFISHMAN EHGMAP: Cardiorespiratory failure in kyphoscoliosis. Medicine 38: 263, 1959. CrossrefMedlineGoogle Scholar21. FISHMANTURINOBERGOFSKY APGMEH: The syndrome of alveolar hypoventilation. Amer. J. Med. 23: 333, 1957. CrossrefMedlineGoogle Scholar22. RILEYCOURNAND RLAF: Pulmonary function studies in relation to chest surgery. Advances Surg. 2: 1, 1949. MedlineGoogle Scholar23. CAMPBELL EJ: The Respiratory Muscles and the Mechanics of Breathing, Lloyd-Luke, London, 1958, Chap. 15. Google Scholar24. CHERNIACKSNIDAL RMDP: The effect of obstruction to breathing on the ventilatory response to CO2. J. Clin. Invest. 35: 1286, 1956. CrossrefMedlineGoogle Scholar25. MEADLINDGRENGAENSLER JLEA: The mechanical properties of the lung in emphysema. J. Clin. Invest. 34: 1005, 1955. CrossrefMedlineGoogle Scholar26. SIEBENSKIRBYPUOLOS AANAD: Cough following transection of spinal cord at C-6. Arch. Phys. Med. 45: 1, 1964. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: EDWARD H. BERGOFSKY, M.D.Affiliations: New York, New YorkFrom the Department of Physical Medicine and Rehabilitation, and the Department of Physiology, School of Medicine, New York University, New York, N. Y.This investigation was supported by grant U-1249 of the Health Research Council of the City of New York.Requests for reprints should be addressed to Edward H. Bergofsky, M.D., Department of Physiology, New York University Medical Center, 550 First Ave., New York, N. Y. 10016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byNovel Influences of Sex and APOE Genotype on Spinal Plasticity and Recovery of Function after Spinal Cord InjuryTraumatic Spinal Cord InjuryEffects of overground locomotor training on the ventilatory response to volitional treadmill walking in individuals with incomplete spinal cord injury: a pilot studyNeurogenic Respiratory FailureThe Effects of Aquatic Exercise on Pulmonary Function in Patients with Spinal Cord InjurySleep Disorders in Spinal Cord InjuryPulmonary Function and Expiratory Flow Limitation in Acute Cervical Spinal Cord InjuryVentilatory Response to Hypercapnia in C5–8 Chronic Tetraplegia: The Effect of PosturePulmonary function and spinal cord injuryDefinitive Establishment of Airway Control is Critical for Optimal Outcome in Lower Cervical Spinal Cord InjuryIntermittent Positive-Pressure Breathing Effects in Patients With High Spinal Cord InjuryDeterminants of Lung Volumes in Chronic Spinal Cord InjuryRespiratory managementCholinergic bronchomotor tone and airway caliber in tetraplegic patientsVentilation Efficiency and Pulmonary Function After a Wheelchair Interval-Training Program in Subjects With Recent Spinal Cord InjuryEffects of Partial Isothermic Immersion on the Spirometry Parameters of Tetraplegic PatientsEtiology and incidence of rehospitalization after traumatic spinal cord injury: A multicenter analysis11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.Gas exchange during separate diaphragm and intercostal muscle breathingPulmonary complications of chronic neuromuscular diseases and their managementEffect of Spinal Cord Injury on the Respiratory SystemRespiratory Dysfunction in Patients With Chronic-Onset Cervical MyelopathyCan early extubation and intensive physiotherapy decrease length of stay of acute quadriplegic patients in intensive care? A retrospective case control studyManagement of Acute Cervical Spinal Cord InjuryVentilatory and Respiratory Muscle Responses to Hypercapnia in Patients with ParaplegiaThe Respiratory System in Spinal Cord InjuryManagement of cervical spine injuryLong-term medical complications after traumatic spinal cord injury: A regional model systems analysisSafety and Efficacy of 4-Aminopyridine in Humans with Spinal Cord Injury: A Long-Term, Controlled TrialVentilatory and mouth occlusion pressure responses to hypercapnia in chronic tetraplegiaOxygen desaturations during exercise and sleep in fit tetraplegic patientsHead position and its effect on pulmonary function in tetraplegic patientsLate return of diaphragm function in a ventilator-dependent patient with a high cervical tetraplegia: case report, and interactive reviewBronchodilatory effects of ipratropium bromide in patients with tetraplegiaBronchial Hyperresponsiveness After Cervical Spinal Cord InjuryChest wall motion before and during mechanical ventilation in children with neuromuscular diseasePulmonary obstruction in individuals with cervical spinal cord lesions unmasked by bronchodilator administrationArterial oxygen saturation over time and sleep studies in quadriplegic patientsThe Respiratory System in Spinal Cord InjuryVentilatory and P0.1 response to hypercapnia in quadriplegiaBreathing pattern adjustments during the first year following cervical spinal cord injuryAcute Cervical Spinal Cord InjuryMaschinelle Beatmung bei polytraumatisierten tetraplegischen PatientenMedical Complications of Spinal Cord DiseaseThe expiratory muscles in tetraplegiaEffect of respiratory training with a mouth-nose-mask in tetraplegicsStationary Exercise Rehabilitation: Introduction and OverviewPathophysiology and Management of Spinal Cord TraumaSpeech Breathing in Individuals with Cervical Spinal Cord InjuryObstructive disordered breathing during sleep in patients with spinal cord injuryRespiratory Complications and Management of Spinal Cord InjuriesRespiratory function in patients with spinal cord injuries: effects of postureCough in Tetraplegic Subjects: An Active ProcessMarc Estenne, MD, André De Troyer, MDVentilatory muscle endurance training in quadriplegia: effects on breathing patternImproved pulmonary function in chronic quadriplegics after pulmonary therapy and arm ergometryRehabilitation bei HalsmarkläsionenFunctional Electrical Stimulation and Its Application in the Rehabilitation of Neurologically Injured IndividualsCritical Care Management of the Patient with Acute Spinal Cord InjuryAnesthetic Considerations in the Patient with Acute Spinal Cord InjuryCervical injuries-anaesthetic implications, monitoring and managementManagement of Spinal Cord Injury in the Critical Care SettingIntermittent Positive Pressure Breathing in Patients with Respiratory Muscle WeaknessLong-term Outlook in Quadriplegic Patients with Initial Ventilator DependencyThe artificial ventilation of acute spinal cord damaged patients: a retrospective study of forty-four patientsMeasurement of abdominal wall compliance in normal subjects and tetraplegic patients.Mechanism of Active Expiration in Tetraplegic SubjectsVentilatory Compromise in Spinal Cord Injury—A ReviewContribution of the rib cage to breathing in tetraplegia.Acute Cervical Spinal InjuryDiaphragmatic function following cervical cord injury: Neurally mediated improvementDisorders of the Chest Wall and DiaphragmAcute Cervical Spinal Cord InjuriesSpinal cord injuries.Lung volumes and mechanics of breathing in tetraplegicsThe effect of training on strength and endurance of the diaphragm in quadriplegiaUse of Biofeedback in Weaning Paralyzed Patients from RespiratorsExperience with the management of thromboembolism in patients with spinal cord injury: part I. incidence, diagnosis and role of some risk factorsRespiratory complications in traumatic quadriplegiaDifferential Diagnosis of Chronic Respiratory InsufficiencyChest movements and electromyography of the intercostal muscles in tetraplegic patientsChest injuries and complications in the early stages of spinal cord injuryCor pulmonale in the syndrome of alveolar hypoventilationA Physiological Classification of Cor Pulmonale 1 September 1964Volume 61, Issue 3Page: 435-447KeywordsMusclesParalysisRehabilitation medicineRespirationRespiratory failureRespiratory physiologyRibsSpinal cord ePublished: 1 December 2008 Issue Published: 1 September 1964 PDF downloadLoading ...