Lesión medular y repercusión en el sistema respiratorio

Abstract

INTRODUCTION The dysfunction of the respiratory system and the breathing complications in the spinal cord injured persons have an effect on the morbidity and the mortality of the disease. The degree of respiratory involvement caused by the dysfunction of the respiratory muscles is related to the degree and the location of the neurological injury, as well as, its evolutionary time. OBJECTIVES Translating to Spanish and validating the questionnaire of international consensus: “INTERNATIONAL SPINAL CORD INJURY PULMONARY FUNCTION BASIC DATA SET”. Determining the influence of the chronicle spinal cord injury in the respiratory system in terms of respiratory functionalism. Analyzing the existence of other variables that could affect the respiratory function and the strength of the respiratory muscles in order to get more information for the management. MATERIALS AND METHODS Translation to Spanish and validation of the questionnaire of international consensus intended for the study of the pulmonary function in spinal cord injury disease. Testing the reliability of that questionnaire. Realization of a descriptive transversal study to determine the degree of affectation of the respiratory system and its repercussion in chronicle traumatic spinal cord injury patients with different neurological levels according to ASIA classification. RESULTS According to the consensus questionnaire the 91.9% did not have any respiratory pathology before the spinal cord injury and the 54.8% of the patients used to smoke. The 27.4% presented breathing complications one year after the injury, being pneumonia the most frequent one. The results of the respiratory function tests were FVC 67%, FEV1 72% and PEF 70%. The concordance and reliability were 98%. The 96.8% of the patients presented dysfunction in the respiratory muscles, being the ones with highest injuries those that had severe affectation (71%). Dysfunction of the inspiratory muscles was found in the 50% of the patients, being moderated in a 32.3% and severe in the 17.7%. Correlation between the PIM value and the degree of neuronal affectation has been found. However, a poor correlation has been seen between the PCT and the dysfunction of the respiratory muscles. Making a multiple regression study between the cough peak and the strength of the respiratory muscles, it is possible to appreciate that the correlation of the PIM is greater than the one of the PEM for all the neurological levels. CONCLUSIONS The questionnaire of international consensus about the pulmonary function is a useful tool for the study of the respiratory affectation in the spinal cord injury. The standardized use of that questionnaire makes it easier to compare between different hospitals and countries. A most exhaustive study of the respiratory functionalism, including the study of the maximum respiratory pressures and the cough peak, is recommended in those patients with risk of presenting breathing complications or deterioration of the pulmonary function.

Date of Award	25 Nov 2014
Original language	Spanish
Supervisor	Miguel Àngel González Viejo (Director) & Joan Nardi Vilardaga (Director)