How can respiratory complications be managed acutely?

Author: Sharon Jang | Reviewer: Tova Plashkes | Published: 24 September 2020 | Updated: 7 December 2021

Efficient removal of mucus from the airways is important to prevent choking and lung infections, especially when independent coughing is difficult. Although research on the topic of secretion removal techniques is scarce, one study with moderate evidence showed that manual removal techniques combined with mechanical removal techniques are effective in SCI early after injury. Different techniques are outlined below:

Certain body positions can use gravity to drain mucus towards the throat to be excreted easier. For example, laying on your side with your feet elevated can help drain the lower lung. In order for these positions to be effective, your body must be positioned in specific angles. Refer to your healthcare professional for more information. To facilitate breakup and movement of the mucus buildup in the lungs, postural drainage can be paired with applying pressure to the chest (chest percussion) or shaking the chest (vibration).

Physical pressure is applied to the chest or abdomen right before expiration to help the individual breathe out. This can be done on yourself or by a trained family member or caregiver.

There are machines that help loosen secretions, clear mucus, and can trigger a cough. They work by delivering a deep breath by pushing air into the lungs, then facilitate exhalation by sucking the air out.

A tube can be inserted through the mouth or tracheostomy site to suction mucus that is stuck in the upper airways. Suctioning may also reflexively trigger a cough.

For a review of what we mean by “strong”, “moderate”, and “weak” evidence, refer to the SCIRE Community Evidence Ratings.

Weak inspiratory muscles can result in breathlessness. Like exercise training, inspiratory muscle strength and endurance can increase with training and decrease bouts of shortness of breath (dyspnea) and coughing. Inspiratory muscle training involves using devices that create resistance when breathing in.

Resistive trainers have adjustable settings that allow individualized training programs.⁵

Refer to our article on Inspiratory Muscle Training for more information!

People with tetraplegia have increased sensitivity of their airways, resulting in more frequent narrowing. To treat this, a family of drugs called bronchodilators can be used to enlarge the airways for air to pass through with more ease. The use of bronchodilators is supported by multiple (weak evidence) studies, which have found that bronchodilators can help improve expiration among individuals with tetraplegia. There is also one strong evidence study that indicates that the bronchodilator salmeterol can improve both respiratory functioning and the strength of breathing muscles. While bronchodilators can help positively influence respiratory functioning, their use carries a potential negative side effect of thickening mucus.