E • COMPLICATIONS
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From the electrocardiographic findings, it is quite clear that before the cardiac arrest
started there was a profound brachycardia identical with that observed in visceral
distension and hyperactivity in other internal organs (Guttmann & Whitteridge, 1947;
Guttmann, 1953-54, 1965, and others).
All this shows how circumspect one has to be when contemplating tracheostomy in
spinal injured patients.
Discontinuing artificial respiration
As soon as respiratory power has improved and the vital capacity is adequate—i.e. 500-
800 ml, the patient should be weaned off the respirator. He is gradually disconnected
from the respirator and is encouraged to breathe spontaneously for short periods which
are gradually increased without exhausting the patient. Electrical stimulation of the
phrenic nerves to exercise the diaphragm may be useful and accelerate the return of
spontaneous respiration but it was not found to be necessary in our patients. When the
spontaneous respiration is satisfactory during most hours of the day attempts should be
made to let him sleep without the respirator for a certain period of the night. During
that period many patients need reassurance that they will wake up if the respiration
becomes inadequate and will not die in their sleep, which is their anxiety. Sleeping
tablets are, of course, contra-indicated.
The cuff of the tracheostomy tube can be permanently deflated once it is ascertained
that he can swallow food by mouth easily.
Healing of the tracheostomy wound is not infrequently delayed but only in the
minority of cases may surgical closure or plastic repair be necessary.
