Cough in spinal cord injured patients: the relationship between motor level and peak expiratory flow.

Pulmonary complications remain a major cause of morbidity and mortality in patients with higher level spinal cord injury. Neurologically intact individuals can cough in order to clear their air passage of lung secretions and foreign material. Patients with higher level cord injuries, with paralysis of the trunk and abdominal muscles, may not have the ability to generate an effective cough. If coughing is dependent on a caregiver, these patients will cough with reduced frequency. Because the innervation to the muscles involved in cough consists of nerves that arise from varying levels of the spinal cord, some patients with spinal cord injury have partial control over these muscles and thus can cough, though with reduced efficacy. Two hundred patients with varying levels of spinal cord injury were studied to determine if motor level and cough ability are correlated. Cough efficacy was measured using a peak expiratory flowmeter while patients were seated at 90 degrees. We concluded that there is indeed a direct relationship between motor level and peak expiratory flow produced during coughing.

Cough in spinal cord injured patients: comparison of three methods to produce cough.

Pulmonary complications are the major causes of morbidity and mortality for persons with cervical spinal cord injury. Diminished ability to cough constitutes a major contribution to the high incidence of pulmonary morbidity in this population. This article reports preliminary results for a new technique for providing assisted cough in this population. In this study, efficacy of cough (as measured by peak expiratory flow rate) was measured under three conditions: volitionally with no assistance, with manual assist of a therapist, and with electrical stimulation of abdominal muscles. Coughs produced by electrical stimulation were approximately as effective as manually assisted coughs. The results suggest this technique is worthy of more detailed study and may be a potentially effective new modality for assisting spinal cord injured persons to clear their airways.

Pressure sore anemia: response to erythropoietin.

Anemia in patients with grade IV pressure sores is usually refractory to therapy with iron salts, and red cell transfusions are commonly required when reconstructive surgery is performed. The anemia is characterized by hypoferremia, reticulocytopenia, and normal-to-increased serum ferritin. Five patients with this anemia were treated with recombinant human erythropoietin (rHuEPO) in doses of 50 to 100 U/kg, given subcutaneously three times per week. The hemoglobin increased in every patient; the mean (+/- SD) value at the initiation of treatment was 8.8 +/- 1.0 g/dL, and after a median of 4 weeks of therapy, it was 12.4 +/- 1.6 g/dL (p less than .001). No adverse effects of treatment were observed. It is concluded that rHuEPO is a promising new agent for pressure sore anemia, but randomized, controlled clinical trials will be required to firmly establish its place in the management of patients with this type of anemia.