Determinants of Forced Expiratory Volume in 1 Second (FEV1), Forced Vital Capacity (FVC), and FEV1/FVC in Chronic Spinal Cord Injury

AbstractCervical and upper thoracic spinal cord injury causes impairments in respiratory muscle performance, leading to variable degrees of pulmonary dysfunction and rendering deep breathing difficult for affected individuals. In this retrospective study, we investigated the effects of self-directed respiratory muscle training in this context by assessing pulmonary function relative to spinal cord injury characteristics. A total of 104 spinal cord injury patients (tetraplegia/paraplegia; 65/39, acute/subacute/chronic; 14/42/48) were admitted for short-term (4–8 weeks) in-patient clinical rehabilitation. Initial evaluation revealed a compromised pulmonary function with a percentage of predicted value of 62.0 and 57.5 in forced vital capacity in supine and forced vital capacity in sitting positions, respectively. Tetraplegic patients had more compromised pulmonary function compared with paraplegic patients. At follow-up evaluation, the percentage of predicted value of forced vital capacity in supine and sitting position improved overall on average by 11.7% and 12.7%, respectively. The peak cough flow improved by 22.7%. All assessed pulmonary function parameters improved significantly in all subgroups, with the greatest improvements found in patients with tetraplegia and subacute spinal cord injury. Therefore, short-term self-directed respiratory muscle training should be incorporated into all spinal cord injury rehabilitation regimens, especially for patients with tetraplegia and subacute spinal cord injury, as well as those with chronic spinal cord injury.

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Pulmonary Complications of Acute Spinal Cord Injuries

Neurosurgery ◽

10.1227/00006123-198708000-00010 ◽

1987 ◽

Vol 21 (2) ◽

pp. 193-196 ◽

Cited By ~ 83

Author(s):

David H. Reines ◽

Robert C. Harris

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Forced Vital Capacity ◽

Vital Capacity ◽

Spinal Cord Injuries ◽

Pulmonary Complications ◽

Neurological Deficits ◽

Respiratory Problems ◽

Cord Injury ◽

The Mean

Abstract The records of 123 consecutive patients admitted with spinal cord injury were examined for the presence of pulmonary complications. Forty-nine had tetraplegia and 23 had paraplegia; the remainder suffered a variety of neurological deficits. Multiple injuries were encountered in 36 patients. Fifty-three pulmonary complications were noted in 44 (35.7%) patients. The most common problems were atelectasis and pneumonia. There were 22 (18%) deaths. Fourteen deaths were related to pulmonary complications. The mean age of patients who died was 52 ± 13 (SE) compared to 28 ± 12 for survivors. A mean forced vital capacity (FVC) of 1127 ± 410 cc in patients suffering respiratory difficulties compared to a FVC of 1865 ± 85 cc in patients without complications (P < 0.001). Oxygenation (PaO2 90 ± 19 torr) was normal in patients without respiratory problems and was abnormal in patients developing problems (PaO2 76 ± 30 torr; P < 0.05). Twenty patients were treated with a rotating bed. The complication rate of patients on the bed was only 10%. In conclusion, respiratory problems remain a significant cause of morbidity and mortality in spinal cord injury. The forced vital capacity, blood oxygen tension, and age are predictors of pulmonary complications. The use of a multidisciplinary approach and a rotating bed may minimize these problems.

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Lung mechanics in individuals with spinal cord injury: effects of injury level and posture

Journal of Applied Physiology ◽

10.1152/jappl.2001.90.2.405 ◽

2001 ◽

Vol 90 (2) ◽

pp. 405-411 ◽

Cited By ~ 96

Author(s):

Ahmet Baydur ◽

Rodney H. Adkins ◽

Joseph Milic-Emili

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Supine Position ◽

Vital Capacity ◽

Forced Expiratory Volume ◽

Lung Mechanics ◽

Cord Injury ◽

Forced Expiratory Flow ◽

Cervical Injuries ◽

High Cervical

Individuals with spinal cord injury (SCI) exhibit reduced lung volumes and flow rates as a result of respiratory muscle weakness. These features have not, however, been investigated in relation to the combined effects of injury level and posture. Changes in forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, forced expiratory flow at 50% vital capacity (FEF50), inspiratory capacity (IC), and expiratory reserve volume (ERV) were assessed by injury level in the seated and supine positions in 74 individuals with SCI. The main findings were 1) FVC, FEV1, and IC increased with descending SCI level down to T10, below which they tended to level off; 2) supine values of FVC and FEV1 tended to be larger in the supine compared with the seated posture down to injury level T1, caudad to which they were less than when seated; 3) IC increased proportionately more down to injury level L1, below which it declined slightly and plateaued; 4) ERV was measurable even at high cervical injuries, was generally smaller in the supine position, reached peak values in both positions at T10injury level, and then rapidly declined at lower levels; 5) when subjects were separated according to current, former, and never smokers, only formerly smoking paraplegic individuals demonstrated spirometric values significantly less than paraplegic individuals who never smoked. Changes in spirometric measurements in SCI are dependent on injury level and posture. These findings support the concept that the increase in vital capacity in supine position is related to the effect of gravity on abdominal contents and increase in IC.

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