Published ahead of print on March 16, 2006, doi:10.1164/rccm.200601-097CR Am. J. Respir. Crit. Care Med., Volume 173, Number 12, June 2006, 1386-1389 A more recent version of this article appeared on June 15, 2006
Submitted on January 23, 2006 Spinal Cord Stimulation: A New Method to Produce an Effective Cough in Spinal Cord Injured PatientsAnthony F DiMarco1*,1 MetroHealth Medical Center, Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio, USA, 2 MetroHealth Medical Center, Department of Neurological Surgery, Case Western Reserve University, Cleveland, Ohio, USA * To whom correspondence should be addressed. E-mail: afd3{at}cwru.edu.
Patients with spinal cord injury have an increased risk of developing respiratory tract infections as the result of expiratory muscle paralysis and consequent inability to cough. We have developed a method by which the expiratory muscles can be activated via lower thoracic and upper lumbar spinal cord stimulation to produce an effective cough mechanism. In a tetraplegic patient who required frequent (mean ± SEM = 8.57 ± 2.3 times per week) caregiver assistance to facilitate airway clearance and expectoration of secretions, three epidural electrodes were applied in the T9, T11 and L1 spinal cord regions. During stimulation at the T9 and L1 levels, airway pressures were 90 and 82 cm H2O, respectively; peak expiratory flow rates were 6.4 L/s and 5.0 L/s. During combined (T9+L1) stimulation, airway pressure and expiratory flow rate increased to 132 cm H2O and 7.4 L/s, respectively. Addition of the third lead did not result in any further increases in pressure generation. These values are characteristic of those observed with a normal subject. Since the patient is able to trigger the device independently, he no longer requires caregiver support for airway management. If confirmed in additional patients, spinal cord stimulation may be a useful method to restore an effective cough mechanism in patients with spinal cord injury. Key words: spinal cord injuries, cough
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