HIỆU QUẢ CỦA KẾT HỢP ĐA PHƯƠNG THỨC: ĐIỀU TRỊ NỘI KHOA VÀ PHỤC HỒI CHỨC NĂNG VẬN ĐỘNG Ở BỆNH NHÂN SUY HÔ HẤP CẤP DO TỔN THƯƠNG TỦY CỔ

Abstract

Cervical spinal cord injuries often disrupt neural pathways from the brain to the respiratory muscles, leading to paralysis of the diaphragm and other respiratory muscles. Patients with cervical spinal cord injuries from various causes are at high risk of being unable to maintain spontaneous ventilation and often require long-term mechanical ventilation. However, prolonged dependence on mechanical ventilation can lead to serious complications such as ventilator-associated pneumonia, tracheal stenosis, tracheoesophageal fistula, pneumothorax, oxygen toxicity, ventilator-induced lung injury, atelectasis, thromboembolism, and even death. Additionally, the weakness and paralysis of the respiratory muscles make weaning from mechanical ventilation extremely challenging and increase the risk of complications during the weaning process, such as hypoxemic and/or hypercapnic respiratory failure, mucus plug-induced atelectasis, and ventilator-associated pneumonia. In this report, we present a case of ventilator-dependent respiratory failure for two years due to transverse myelitis from C1 to T2. The patient was transferred from a provincial hospital to the HCMC Hospital for Rehabilitation - Professional Diseases. The weaning process was complicated by increased mucus secretion, pneumonia, atelectasis, and coma due to hypercapnic respiratory failure. The patient underwent a prolonged weaning process with intensive medical management according to the treatment protocol, combined with physical therapy and rehabilitation. After six months of multidisciplinary treatment, the patient was successfully weaned off the ventilator and discharged with stable clinical status.