title: Noninvasive respiratory management of high level spinal cord injury.
abstract: This article describes noninvasive acute and long-term management of the respiratory muscle paralysis of high spinal cord injury (SCI). This includes full-setting, continuous ventilatory support by noninvasive intermittent positive pressure ventilation (NIV) to support inspiratory muscles  and mechanically assisted coughing (MAC) to support inspiratory and expiratory muscles. The NIV and MAC can also be used to extubate or decannulate 'unweanable' patients with SCI, to prevent intercurrent respiratory tract infections from developing into pneumonia and acute respiratory  failure (ARF), and to eliminate tracheostomy and resort to costly electrophrenic/diaphragm pacing (EPP/DP) for most ventilator users, while permitting glossopharyngeal breathing (GPB) for security in the event of ventilator failure.
authors.affiliation: Department of Physical Medicine & Rehabilitation, University Hospital, NY, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Bach
mesh_terms: D006801:Humans; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy*; D013119:Spinal Cord Injuries / Q000150:complications* / Q000628:therapy*