Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2006 Jun 15;173(12):1386-9.
doi: 10.1164/rccm.200601-097CR. Epub 2006 Mar 16.

Spinal cord stimulation: a new method to produce an effective cough in patients with spinal cord injury

Anthony F DiMarco  1 , Krzysztof E Kowalski, Robert T Geertman, Dana R Hromyak
Affiliations
Case Reports

Spinal cord stimulation: a new method to produce an effective cough in patients with spinal cord injury

Anthony F DiMarco et al. Am J Respir Crit Care Med. .

Abstract

Patients with spinal cord injury have an increased risk of developing respiratory tract infections as the result of expiratory muscle paralysis and consequent inability to cough. We have developed a method by which the expiratory muscles can be activated via lower thoracic and upper lumbar spinal cord stimulation to produce an effective cough mechanism. In a tetraplegic patient who required frequent (8.57+/-2.3 times per week [mean+/-SEM]) caregiver assistance to facilitate airway clearance and expectoration of secretions, three epidural electrodes were applied in the T9, T11, and L1 spinal cord regions. During stimulation at the T9 and L1 levels, airway pressures were 90 and 82 cm H2O, respectively. Peak expiratory flow rates were 6.4 L/s and 5.0 L/s; respectively. During combined (T9+L1) stimulation, airway pressure and expiratory flow rate increased to 132 cm H2O and 7.4 L/s, respectively. Addition of the third lead did not result in further increases in pressure generation. These values are characteristic of those observed with a normal subject. Because the patient is able to trigger the device independently, he no longer requires caregiver support for airway management. If confirmed in additional patients, spinal cord stimulation may be a useful method to restore an effective cough mechanism in patients with spinal cord injury.

PubMed Disclaimer

Figures

<b>Figure 1.</b>
Figure 1.
Representative tracings of expiratory flow and airway pressure during stimulation at T9 (40 V, 53 Hz, 150 μs), L1 (40 V, 53 Hz, 200 μs), and combined stimulation (T9+L1) at TLC.
<b>Figure 2.</b>
Figure 2.
Mean changes ± SEM in airway pressure generation during stimulation at T9, T11 (40 V, 53 Hz, 200 μs), L1 and combined stimulation (T9+T11+L1) at FRC and TLC (stimulus parameters same as Figure 1).
<b>Figure 3.</b>
Figure 3.
Relationship between stimulus frequency and mean airway pressure generation ± SEM during stimulation at T9, L1, and combined stimulation (T9+L1) at FRC (stimulus parameters same as Figure 1).
See this image and copyright information in PMC

References

    1. DeTroyer A, Estenne M, Heilporn A. Mechanism of active expiration in tetraplegic subjects. N Engl J Med 1986;314:740–744. - PubMed
    1. Estenne M, DeTroyer A. Cough in tetraplegic subjects: an active process. Ann Intern Med 1990;112:22–28. - PubMed
    1. Kelly BJ, Luce JM. The diagnosis and management of neuromuscular diseases causing respiratory failure. Chest 1991;99:1485–1494. - PubMed
    1. McMichan JC, Michel L, Westbrook PR. Pulmonary dysfunction following traumatic quadriplegia: recognition, prevention and treatment. JAMA 1980;243:528–531. - PubMed
    1. Carter RE. Respiratory aspects of spinal cord injury management. Paraplegia 1987;25:262–266. - PubMed

Publication types