title: Resolution of tracheostomy complications by decanulation and conversion to noninvasive management for a patient with high-level tetraplegia.
abstract: OBJECTIVE
  To report conversion from tracheostomy (TIV) to noninvasive intermittent positive pressure ventilation (NIV) for a continuously ventilator-dependent patient with high-level spinal cord injury (SCI) with no measurable vital capacity (VC = 0 mL) to resolve tracheostomy-associated complications.
  
  
  METHODS
  A case report of a 38-year-old female in a chronic care facility in Japan with a 10-year history of ventilator-dependent tetraplegia (C1 ASIA-A) presented for increasing difficulty vocalizing. She had been using a fenestrated cuffed tracheostomy tube to produce speech with the cuff deflated. Speech was increasingly hypophonic, because of tracheostoma enlargement, tube migration, and tracheal granulation.
  
  
  RESULTS
  The NIV was provided via nasal and oral interfaces, the ostomy was surgically closed, and vocalization resumed. Airway secretions were expulsed using manually assisted coughing. The patient returned to the community.
  
  
  CONCLUSIONS
  Conversion to NIV should be considered for ventilator-dependent patients with SCI who have adequate bulbar-innervated muscle function to permit effective speech and assisted coughing.
authors: Department of Rehabilitation, Kansai Rosai Hospital , Amagasaki, Hyogo , Japan.
authors: Akiko
authors: A
authors: Toki
authors: Kozo
authors: K
authors: Hanayama
authors: Yuka
authors: Y
authors: Ishikawa
keywords: cough; mechanical ventilation; respiratory paralysis; spinal cord injury; tetraplegia