Respiratory Dysfunction & Pneumonia

Respiratory complications and infection predominate as post-SCI complications. When the injury involves the upper thorax, the normal breathing pattern is permanently altered. The diaphragm does most of the work in quiet breathing. The chest wall muscles (intercostals) are used primarily for deep breathing or coughing. The abdominal muscles also participate in coughing.  When the intercostal and abdominal muscles are paralyzed, the entire load is taken by the diaphragm. This results in poor coughing and a high risk of pneumonia.  Pneumonia is one of the most common complications of acute spinal cord injury. Preventive measures are very important to reduce the risk of pneumonia.  These include: percussion and drainage using gravity to assist; assisted coughing (also termed "quad" coughing); abdominal binders (to increase the resistance against which the diaphragm works); and early mobilization (i.e.; getting the patient out of bed as soon as possible.