Ventilator Use After a Spinal Cord Injury (SCI)

People with high-level cervical spinal cord injury (SCI) may be unable to breathe on their own. In these cases, a machine called a ventilator may be used to help with breathing. If you use a ventilator, your care team will help you and your loved ones adjust to it and use it safely.

Home ventilators are often small and portable. Most types can be attached to wheelchairs. They can also be set up by the bed for use when sleeping.

A ventilator works by pushing air (and extra oxygen, if needed) into the lungs. Common ways to deliver the air are through a tracheostomy (trach) tube or tightly fitted face mask. If a trach tube is used, it is placed through a small hole (stoma) in the front of the neck and directly into the windpipe. If a mask is used, it is fitted over the nose, mouth, or both. The trach tube or mask is then connected to the ventilator.

Ventilators can deliver different types of breaths, such as volume control and volume assist, pressure control and pressure assist, and pressure support. Some people need to use the ventilator all of the time. Others may only need it at certain times, such as when sleeping.

You will likely need help at home with your ventilator. You may also need more help with your daily care routine. Things that you may need help with include:

• Using and maintaining your equipment. For your safety, it is crucial that you and your caregiver know how to use your equipment. Built-in alarms will alert you and your caregiver when there is a problem. But your caregiver should know when to call 911 and be ready to give manual breathing assistance, if needed. Also your ventilator needs a steady power source to work correctly. It can run on batteries or be plugged into an electrical outlet. But it must be recharged daily. Have a backup power source and extra batteries ready in case of a power failure or other emergency.
• Keeping your airway clear. Many people with breathing problems also have problems coughing. When this happens, too much mucus can build up in the lungs and airway. This makes pneumonia and other lung problems more likely. Your caregiver may need to do regular suctioning to remove excess mucus from your lungs and trach tube, if you have one. They may also need to use assisted coughing methods (also called quad coughing) to help move mucus out of your lungs. In some cases, a special cough machine may also be used to help bring up mucus.
• Tracheostomy or nose and mouth care. If you have a trach tube, the tube will need to be cared for and changed regularly. The skin and area around the stoma will also need to be cleaned daily to prevent infection. If you have a mask, the skin around the nose and mouth will need special care. Your caregiver can be shown the best ways to help with these care needs. This can increase your comfort and make problems less likely.

Along with the basic care you will need every day, you may have other concerns. These can include:

• Help with communicating. Your trach tube or mask may interfere with your ability to talk. Even if you have a speaking valve for your tube or if you can remove your mask for talking, the quality of your voice may be weak. You may not be able to speak very loudly or for long periods. A speech therapist can help you learn ways to make it easier to communicate.
• Help with eating. Some people with a ventilator are able to eat normally. Others are at increased risk for aspiration (when food or liquids, even saliva, goes into the lungs). Still others may be unable to eat by mouth. In such cases, they may need equipment, such as a feeding tube, to help get nutrition. Your doctor will let you know if further care is needed for issues with eating.
• Help adjusting. It takes time to adjust to using a ventilator. If you're having trouble coping, tell your care team. They can help you get the support you need.

Using a ventilator for breathing can be challenging. But with help from your care team and those closest to you, you can still find ways to be active and live well. See your care team for ongoing care as advised. This allows them to watch your health and progress. This also helps them support you in setting goals and achieving the best function possible.