Diaphragm Pacing and a Model for Respiratory Rehabilitation After Spinal Cord Injury.
Diaphragm Pacing and a Model for Respiratory Rehabilitation After Spinal Cord Injury.
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DOI：
10.1097/npt.0000000000000360
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发表时间：
2021-07-01
期刊：
影响因子：
--
通讯作者：
Fox EJ
中科院分区：
文献类型：
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作者：
Cavka K;Fuller DD;Tonuzi G;Fox EJ
颈脊髓损伤（CSCI）可导致严重的呼吸障碍。尽管机械通气（MV）是这些患者的救生护理标准，但它与横膈膜萎缩和功能障碍有关。膈肌起搏（DP）是目前用于促进MV脱机和对抗相关负面影响的一种策略。初步报告表明，DP也可能促进神经肌肉可塑性，并导致自发性膈肌激活和呼吸功能的改善。这些结果表明，需要重新评估使用DP的CSCI患者的呼吸康复，并考虑这些患者及其独特的护理需求的新的康复模式。本文讨论了考虑DP作为一种康复策略的基本原理，特别是当与既定的呼吸干预措施结合使用时。此外，呼吸康复和恢复（RRR）的模型，提供了一个框架，康复和考虑DP作为一种辅助康复方法。该模型通过跨学科护理、呼吸训练、定量测量和使用DP等辅助策略，促进呼吸恢复和独立以及终身呼吸健康等目标。该模型的应用证明通过描述的住院康复计划，适用于模型组件CSCI患者谁需要DP。随着急性CSCI患者DP使用的增加，为这些患者提供康复方法的需求和机会也在增加。这篇观点论文是解决这一需求和激励CSCI患者康复策略进步的关键一步。(See视频摘要，补充数字内容）
Cervical spinal cord injury (CSCI) can cause severe respiratory impairment. Although mechanical ventilation (MV) is a life-saving standard of care for these patients, it is associated with diaphragm atrophy and dysfunction. Diaphragm pacing (DP) is a strategy now used acutely to promote MV weaning and to combat the associated negative effects. Initial reports indicate that DP also may promote neuromuscular plasticity and lead to improvements in spontaneous diaphragm activation and respiratory function. These outcomes suggest the need for re-evaluation of respiratory rehabilitation for patients with CSCI using DP and consideration of new rehabilitation models for these patients and their unique care needs. This article discusses the rationale for consideration of DP as a rehabilitative strategy, particularly when used in combination with established respiratory interventions. In addition, a model of Respiratory Rehabilitation and Recovery (RRR) is presented, providing a framework for rehabilitation and consideration of DP as an adjuvant rehabilitation approach. The model promotes goals such as respiratory recovery and independence, and life-long respiratory health, via interdisciplinary care, respiratory training, quantitative measurement, and use of adjuvant strategies such as DP. Application of the model is demonstrated through a description of an inpatient rehabilitation program that applies model components to CSCI patients who require DP. As DP use increases for patients with acute CSCI, so does the need and opportunity to advance rehabilitation approaches for these patients. This perspective paper is a critical step in addressing this need and motivating the advancement of rehabilitation strategies for CSCI patients. (See Video Abstract, Supplemental Digital Content)