Atelectasis in spinal cord injured people after initial medical stabilization

Two hundred and forty-three spinal cord injured people were evaluated during 271 consecutive admissions to a spinal cord injury service over four years. These patients all had received initial medical stabilization after spinal cord injury prior to admission. Atelectasis with or without apparent pulmonary infiltrate or pleural effusion was documented in six quadriplegics, all on the left side. Five out of the six had tracheostomies. Atelectasis occurred days to months after injury and initial medical stabilization. The patients often had symptoms and findings suggestive of other illnesses and may have had more invasive diagnostic and therapeutic procedures if the diagnosis of atelectasis was not provisionally made. Associated dyspnea delayed the rehabilitation of several patients. Response to vigorous pulmonary therapy and bronchoscopy, if necessary, was prompt, with complete resolution in less than 24 hours. The inability to clear secretions that caused this problem was responsible for recurrences in three patients. Preventive and therapeutic modalities such as assisted coughing, deep breathing, incentive spirometry, chest percussion, and suctioning, if necessary, should be practiced. Atelectasis may still occur after the original injury.