Pulmonary dysfunction following traumatic quadriplegia. Recognition, prevention, and treatment

A prospective study of the pulmonary complications occurring in 22 consecutive patients admitted to hospital within 24 hours after acute traumatic quadriplegia was compared with the findings of a retrospective survey of 22 comparable patients. Patients in the prospective group received therapy designed to prevent or reverse secretion retention. All patients in this group survived. In the retrospective group there were nine deaths; pulmonary complications and the need for tracheal intubation and mechanical ventilation were three times more frequent. Serial pulmonary function testing in the prospective group demonstrated a greater compromise of expiration than inspiration and progressive improvement in diaphragm function with time. It is concluded that vigorous pulmonary therapy in the prospective group was associated with increased survival, a decreased incidence of pulmonary complications, and a decreased need for ventilatory support.