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• Oxygen and Suction • Heated Molecular Humidity • Abdominal Binders 4. Conduct follow-up respiratory assessments as indicated, throughout the individual’s lifetime. 5. Admit individuals with ventilator dependence to inpatient SCI rehabilitation, and provide interprofessional care to optimize the method of ventilation, and maximize potential for spontaneous breathing. References to Guide Clinical Practice Clinical Practice Guidelines: • Respiratory management, Consortium for Spinal Cord Medicine.15 • Home mechanical ventilation, McKim et al.18 Systematic Reviews: • Respiratory management, Sheel et al.1 • Secretion removal techniques, Reid et al.20 Book Chapters: • Respiratory evaluation, Wetzel.17 • Respiratory dysfunction in SCI, Baydur and Sassoon.2 • Management of respiratory dysfunction, Wetzel.4 • Sleep disorders in SCI, Epstein and Brown.5 Canadian Content Experts Likely to Influence Practice in the Next Five Years 1. Graham Jones, MD (Respirology), Hamilton: Respirologist and intensivist at Hamilton Health Sciences. Provides consultations and follow-up care for inpatients and outpatients with SCI. Expertise in cardiorespiratory assessment, exercise counselling and ventilatory management of individuals with SCI. 2. Douglas McKim, MD (Respirology), Ottawa: Respirologist and Medical Director of Respiratory Rehabilitation Services/CANVent (Canadian Alternatives in Non-Invasive Ventilation) Program, and the Ottawa Sleep Centre. The CANVent Program develops weaning strategies in critical care, and educates healthcare professionals about non-invasive airway clearance strategies, to enable individuals with SCI to participate in rehabilitation. He is the lead author of the 2011 Canadian Thoracic Society Clinical Practice Guidelines on Home Mechanical Ventilation and co-investigator of CIHR-funded projects to study long-term ventilation. 3. Colleen O’Connell, MD (Physiatry), Fredericton: Physiatrist with expertise in respiratory management in SCI and other neurologic conditions, particularly in non-invasive ventilation. Member of the Canadian Home Mechanical Ventilation Guidelines Committee, to assist with regional dissemination and implementation of the guideline. 4. Jeremy Road, MD (Respirology), Vancouver: Respirologist at Vancouver General Hospital and Medical Director of the Provincial Respiratory Outreach Program for individuals on home-assisted ventilation; part of the research team that piloted diaphragm pacing in Canada,and Co-Chair of the Canadian Thoracic Society Home Mechanical Ventilation Committee. He will assist with regional dissemination and implementation of the guideline. 5. Andrea Townson, MD (Physiatry), Vancouver: Physiatrist with research interests in high tetraplegia, ventilator dependency and fatigue. Experienced in the care and management of individuals with high tetraplegia. 6. Renata Vaughan, RRT, Hamilton: Respiratory Therapist at Hamilton Health Sciences Regional Rehabilitation Centre and Clinical Coordinator at the Michener Institute of Applied Health Sciences. Teaches others about respiratory care of individuals with SCI, based on 22 years of experience in SCI rehabilitation, long-term ventilation and noninvasive secretion clearance techniques. Research Implications • Focus strongly on knowledge translation and best practices implementation to achieve a high standard of respiratory care, across the country. • Create guidelines regarding rehabilitation assessment of respiratory function, in individuals with SCI, and a systematic method of evaluating utilization. • Conduct an economic analysis of the value, and cost of implementing respiratory best practices during SCI rehabilitation, to be informative and useful for health policy improvements. Health Policy Implications • SCI rehabilitation should be accessible to all Canadians with SCI in a fair and equitable way. If future analyses of Canadian healthcare data show that respiratory status affects access to specialized SCI rehabilitation, the role of health policy in ensuring appropriate access must be considered • Health policies that change the SCI continuum of care (e.g., shortened acute care stay, admission to community hospitals with limited expertise in SCI care prior to rehab, or shortened rehabilitation stay) can affect respiratory health outcomes of individuals with SCI, and need to be evaluated. INDEPENDENCE IN BREATHING | BODY STRUCTURE AND FNUCTION 83


G - Independence in Breathing
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