Objectives: To report conversion from tracheostomy (TIV) to noninvasive intermittente positive pressure ventilation (NIV) for a continuously ventilator-dependent patient with high-level spinal cord injury (SCI) with no measurable vital capacity (VC = 0 mL) to resolve tracheostomy-associated complications. Methods: A case report of a 38-year-old female in a chronic care facility in Japan with a 10-year history of ventilator-dependent tetraplegia (C1 ASIA-A) presented for increasing difficulty vocalizing. She had been using a fenestrated cuffed tracheostomy tube to produce speech with the cuff defiated. Speech was increasingly hypophonic, because of tracheostoma enlargement, tube migration, and tracheal granulation. Results: The NIV was provided via nasal and oral interfaces, the ostomy was surgically closed, and vocalization resumed. Airway secretions were expulsed using manually assisted coughing. The patient returned to the community. Conclusion: Conversion to NIV should be considered for ventilator-dependent patients with SCI who have adequate bulbar-innervated muscle function to permit effective speech and assisted coughing.

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Top Spinal Cord Inj Rehabil.
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2
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49
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79
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222
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Update and perspectives on noninvasive respiratory muscle aids. Part 1: The inspiratory aids
Chest.
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105
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Bach JR, Alba AS, Bodofsky E, Curran FJ, Schultheiss M. Glossopharyngeal breathing and non-invasive aids in the management of post-polio respiratory insufficiency. Birth Defects. 1987;23(4):99-113.
Glossopharyngeal breathing and non-invasive aids in the management of post-polio respiratory insufficiency
Birth Defects.
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23
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99
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113
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Bach JR. Mechanical insufflation-exsufflation. Comparison of peak expiratory flows with manually assisted and unassisted coughing techniques. Chest. 1993;104:1553-1562.
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Am J Phys Med Rehabil.
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81
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579
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Bach JR. Pulmonary Rehabilitation: The Obstructive and Paralytic Conditions. Philadelphia, PA: Hanley & Belfus; 1996.
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Consortium for Spinal Cord Medicine. Respiratory Management Following Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals. Washington, DC: Paralyzed Veterans of America; 2005.
Consortium for Spinal Cord Medicine
Pulmonary Rehabilitation: The Obstructive and Paralytic Conditions.
Bach JR, Intintola P, Alba AS, Holland I. The ventilator-assisted individual: cost analysis of institutionalization versus rehabilitation and in-home management. Chest. 1992;101(1):26-30.
The ventilator-assisted individual: cost analysis of institutionalization versus rehabilitation and in-home management
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Bach JR. A comparison of long-term ventilatory support alternatives from the perspective of the patient and care giver. Chest. 1993;104(6):1702-1706.
A comparison of long-term ventilatory support alternatives from the perspective of the patient and care giver
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1702
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