Gabi Müller, Clinical Trial Unit, Swiss Paraplegic Centre Nottwil, Nottwil, Switzerland

Respiratory complications in Spinal Cord Injury - Influencing factors and potential for reduction

Funded in: 2014, 2015, 2016

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Problem: After SCI, respiratory function is impaired resulting in pneumonia.

Target: Identification of potential predictors of respiratory function and assessment of predictive parameters for the development of pneumonia in individuals with SCI

Goal: The definition of a ‘pneumonia risk threshold’ from respiratory function parameters will allow for a well-adapted treatment of the respective patients.

Paralysis of respiratory muscles is common after Spinal Cord Injury (SCI). The higher the lesion, the more muscles are affected and the more respiratory function is reduced. This reduction in respiratory function and especially the loss of expiratory muscle innervation produces various problems as e.g. a weak ability to cough. As a consequence, secretion can’t be cleared effectively and independently and the risk of pulmonary infection increases. Individuals with tetraplegia therefore often suffer from pneumonia and other respiratory complications. Unfortunately, pneumonia is still the main cause of death in individuals with chronic SCI. Since respiratory function is more reduced in individuals with higher lesions compared to lower lesions suffer more often from pneumonia, respiratory function may be an important predictor of pneumonia in individuals with SCI.

Therefore, the aim of the study is to
a)    identify potential modifiable predictors of respiratory function and
b)    assess the association of respiratory function to the risk to develop pneumonia in individuals with SCI.

This will be done in 3 parts, 2 in a retrospective cohort design at the Swiss Paraplegic Centre Nottwil and one in a Multi-Center design with 10 SCI-centres from Australia, the Netherlands and Switzerland.

After completion of this project, the team expects to understand which respiratory factors are associated with pneumonia in individuals with SCI, and which possibilities are available to reduce the incidence of pneumonia. They aim to define a ‘pneumonia risk threshold’ from respiratory function parameters to define the optimal training-intensity and -volume to improve respiratory function by a clinically important change.