Document Type

Handbook, Guide or Manual (Third Edition)

Publication Date (Third Edition)




One of the most important aspects of spinal cord injury care is respiratory management. The previous chapter deals with the effect spinal cord injury has on your ability to breathe while this chapter deals with the management of individuals who are dependent on a ventilator to breathe. This dependency may be temporary or permanent, depending on your level of injury. Please review the previous chapter prior to reading this one.

Artificial Airways

The first step in trying to maintain normal respiratory function is to establish an airway. Spinal cord injury does not affect your airway. However, in order to re-establish respiratory function, an artificial airway is needed to work with the ventilator. At first, this is done by using an endotracheal tube (ET tube). This tube is inserted through your nose or mouth and into your trachea. The ET tube has a balloon, which is inflated. This helps to prevent air from leaking into your nose or mouth. The ET tube is held in place with tape to the person’s cheeks. The ET tube provides a passage through which either a manual resuscitator or a ventilator can deliver air.

The ET tube is considered temporary. If the person needs ventilatory assistance for a long time, a tracheostomy may be performed. Tracheostomy tubes are more comfortable for people and provide options for communication that an ET tube cannot. A tracheostomy is a sterile procedure that is done in the operating room. An incision is made into the person’s trachea and a shorter tube, similar to the ET tube, is inserted. The tracheostomy tube is held in place with ties that look similar to a shoestring. Many companies make tracheostomy tubes, each with pluses and minuses. Generally, the first tracheostomy tube that is placed is called a non-fenestrated, cuffed tube. This tube does not allow the individual to speak, and the cuff helps the individual to protect his or her airway from food, as well as helps to keep the air from leaking into the nose and mouth. The tubes can be adapted to meet the individual’s needs. A tracheostomy tube can be replaced or changed as your needs change.

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