{"id":2407,"date":"2022-08-22T04:27:25","date_gmt":"2022-08-22T04:27:25","guid":{"rendered":"https:\/\/langs.physio-pedia.com\/respiratory-management-in-spinal-cord-injury-fr\/"},"modified":"2023-04-18T16:03:01","modified_gmt":"2023-04-18T16:03:01","slug":"respiratory-management-in-spinal-cord-injury-fr","status":"publish","type":"page","link":"https:\/\/langs.physio-pedia.com\/fr\/respiratory-management-in-spinal-cord-injury-fr\/","title":{"rendered":"Traitement respiratoire pour les l\u00e9sions de la moelle \u00e9pini\u00e8re"},"content":{"rendered":"<div class=\"mw-parser-output\">\n<div class=\"editorbox\">\n<p><b>\u00c9diteur original <\/b>&#8211; <a title=\"User:Eugenie Lamprecht\" href=\"\/User:Eugenie_Lamprecht\">Eugenie Lamprecht<\/a><\/p>\n<p><b>Principaux contributeurs<\/b> &#8211; <a class=\"mw-userlink\" title=\"User:Ewa Jaraczewska\" href=\"\/User:Ewa_Jaraczewska\"><bdi>Ewa Jaraczewska<\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Eugenie Lamprecht\" href=\"\/User:Eugenie_Lamprecht\"><bdi>Eugenie Lamprecht<\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Lucinda hampton\" href=\"\/User:Lucinda_hampton\"><bdi>Lucinda hampton<\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Jess Bell\" href=\"\/User:Jess_Bell\"><bdi>Jess Bell<\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Kim Jackson\" href=\"\/User:Kim_Jackson\"><bdi>Kim Jackson<\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Naomi O'Reilly\" href=\"\/User:Naomi_O%27Reilly\"><bdi>Naomi O&rsquo;Reilly<\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Vidya Acharya\" href=\"\/User:Vidya_Acharya\"><bdi>Vidya Acharya<\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Chelsea Mclene\" href=\"\/User:Chelsea_Mclene\"><bdi>Chelsea Mclene<\/bdi><\/a> et <a class=\"mw-userlink\" title=\"User:Kirenga Bamurange Liliane\" href=\"\/User:Kirenga_Bamurange_Liliane\"><bdi>Kirenga Bamurange Liliane<\/bdi><\/a><\/p>\n<\/div>\n<div id=\"toc\" class=\"toc\" role=\"navigation\" aria-labelledby=\"mw-toc-heading\"><input id=\"toctogglecheckbox\" class=\"toctogglecheckbox\" style=\"display: none;\" role=\"button\" type=\"checkbox\"><\/p>\n<div class=\"toctitle\" dir=\"ltr\" lang=\"en\">\n<h2 id=\"mw-toc-heading\">Contenu<\/h2>\n<\/div>\n<ul>\n<li class=\"toclevel-1 tocsection-1\"><a href=\"#Introduction\"><span class=\"tocnumber\">1<\/span> <span class=\"toctext\">Introduction<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-2\"><a href=\"#Normal_Respiration\"><span class=\"tocnumber\">2<\/span> <span class=\"toctext\">Respiration normale<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-3\"><a href=\"#Musculoskeletal\"><span class=\"tocnumber\">2.1<\/span> <span class=\"toctext\">Musculo-squelettique<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-4\"><a href=\"#Neuromuscular\"><span class=\"tocnumber\">2.2<\/span> <span class=\"toctext\">Neuromusculaire<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-5\"><a href=\"#Integumentary_.28Skin.29\"><span class=\"tocnumber\">2.3<\/span> <span class=\"toctext\">T\u00e9gumentaire (peau)<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-6\"><a href=\"#Spinal_Cord_Injury_and_Respiration\"><span class=\"tocnumber\">3<\/span> <span class=\"toctext\">L\u00e9sion de la moelle \u00e9pini\u00e8re et respiration<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-7\"><a href=\"#Respiratory_Complications\"><span class=\"tocnumber\">3.1<\/span> <span class=\"toctext\">Complications respiratoires<\/span><\/a>\n<ul>\n<li class=\"toclevel-3 tocsection-8\"><a href=\"#Cough_and_Secretions\"><span class=\"tocnumber\">3.1.1<\/span> <span class=\"toctext\">Toux et s\u00e9cr\u00e9tions<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-9\"><a href=\"#Mucus_Production\"><span class=\"tocnumber\">3.1.2<\/span> <span class=\"toctext\">Production de mucus<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-10\"><a href=\"#Spastic_Contraction_of_Abdominal_Muscles\"><span class=\"tocnumber\">3.1.3<\/span> <span class=\"toctext\">Contraction spastique des muscles abdominaux<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-11\"><a href=\"#Position_and_Orthoses\"><span class=\"tocnumber\">3.1.4<\/span> <span class=\"toctext\">Position et orth\u00e8ses<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-12\"><a href=\"#Acute_Respiratory_Management\"><span class=\"tocnumber\">4<\/span> <span class=\"toctext\">Prise en charge respiratoire en aigu<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-13\"><a href=\"#Monitoring\"><span class=\"tocnumber\">4.1<\/span> <span class=\"toctext\">Surveillance<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-14\"><a href=\"#Ventilation.2C_Weaning_and_Extubation\"><span class=\"tocnumber\">4.2<\/span> <span class=\"toctext\">Ventilation, sevrage et extubation<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-15\"><a href=\"#Tracheostomy_and_Decannulation\"><span class=\"tocnumber\">4.3<\/span> <span class=\"toctext\">Trach\u00e9otomie et d\u00e9canulation<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-16\"><a href=\"#Physiotherapy_Management_of_Respiration\"><span class=\"tocnumber\">5<\/span> <span class=\"toctext\">Traitement de la respiration par la physioth\u00e9rapie<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-17\"><a href=\"#Patient_Assessment.5B6.5D\"><span class=\"tocnumber\">5.1<\/span> <span class=\"toctext\">\u00c9valuation du patient <sup>(6<\/sup>)<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-18\"><a href=\"#Positioning\"><span class=\"tocnumber\">5.2<\/span> <span class=\"toctext\">Positionnement<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-19\"><a href=\"#Techniques\"><span class=\"tocnumber\">5.3<\/span> <span class=\"toctext\">Techniques<\/span><\/a>\n<ul>\n<li class=\"toclevel-3 tocsection-20\"><a href=\"#Secretion_Mobilisation\"><span class=\"tocnumber\">5.3.1<\/span> <span class=\"toctext\">Mobilisation des s\u00e9cr\u00e9tions<\/span><\/a>\n<ul>\n<li class=\"toclevel-4 tocsection-21\"><a href=\"#Postural_Drainage\"><span class=\"tocnumber\">5.3.1.1<\/span> <span class=\"toctext\">Drainage postural<\/span><\/a><\/li>\n<li class=\"toclevel-4 tocsection-22\"><a href=\"#Suctioning\"><span class=\"tocnumber\">5.3.1.2<\/span> <span class=\"toctext\">Aspiration<\/span><\/a><\/li>\n<li class=\"toclevel-4 tocsection-23\"><a href=\"#Assisted_Coughing_Techniques\"><span class=\"tocnumber\">5.3.1.3<\/span> <span class=\"toctext\">Techniques de toux assist\u00e9e<\/span><\/a><\/li>\n<li class=\"toclevel-4 tocsection-24\"><a href=\"#Percussions_and_Vibrations\"><span class=\"tocnumber\">5.3.1.4<\/span> <span class=\"toctext\">Percussions et vibrations<\/span><\/a><\/li>\n<li class=\"toclevel-4 tocsection-25\"><a href=\"#Mechanical_Insufflation_and_Exsufflation\"><span class=\"tocnumber\">5.3.1.5<\/span> <span class=\"toctext\">Insufflation et exsufflation m\u00e9caniques<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-3 tocsection-26\"><a href=\"#Specialised_Breathing_Techniques\"><span class=\"tocnumber\">5.3.2<\/span> <span class=\"toctext\">Techniques respiratoires sp\u00e9cialis\u00e9es<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-27\"><a href=\"#Stretching_Techniques\"><span class=\"tocnumber\">5.3.3<\/span> <span class=\"toctext\">Techniques d&rsquo;\u00e9tirement<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-28\"><a href=\"#Soft_tissue_release\"><span class=\"tocnumber\">5.3.4<\/span> <span class=\"toctext\">Rel\u00e2chement des tissus mous<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-29\"><a href=\"#Respiratory_Muscle_Training\"><span class=\"tocnumber\">5.3.5<\/span> <span class=\"toctext\">Entra\u00eenement des muscles respiratoires<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-30\"><a href=\"#Non-Invasive_Ventilatory_.28NIV.29_Support\"><span class=\"tocnumber\">5.3.6<\/span> <span class=\"toctext\">Ventilation non invasive (VNI)<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-2 tocsection-31\"><a href=\"#Early_Mobilisation\"><span class=\"tocnumber\">5.4<\/span> <span class=\"toctext\">Mobilisation pr\u00e9coce<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-32\"><a href=\"#Long-Term_Ventilation\"><span class=\"tocnumber\">5.5<\/span> <span class=\"toctext\">Ventilation \u00e0 long terme<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-33\"><a href=\"#References\"><span class=\"tocnumber\">6<\/span> <span class=\"toctext\">R\u00e9f\u00e9rences<\/span><\/a><\/li>\n<\/ul>\n<\/div>\n<h2><span id=\"Introduction\" class=\"mw-headline\">Introduction<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Introduction\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=1\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Introduction\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=1\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>Le dysfonctionnement respiratoire est l&rsquo;une des complications m\u00e9dicales les plus courantes, ainsi que la principale cause de r\u00e9duction de la <a title=\"Quality of Life\" href=\"\/Quality_of_Life\">qualit\u00e9 de vie<\/a> (QdV) et de mortalit\u00e9 chez les personnes atteintes de <a title=\"Spinal Cord Injury\" href=\"\/Spinal_Cord_Injury\">l\u00e9sions de la moelle \u00e9pini\u00e8re<\/a>.<sup id=\"cite_ref-:0_1-0\" class=\"reference\"><a href=\"#cite_note-:0-1\">(1)<\/a><\/sup><sup id=\"cite_ref-:2_2-0\" class=\"reference\"><a href=\"#cite_note-:2-2\">(2)<\/a><\/sup><sup id=\"cite_ref-:1_3-0\" class=\"reference\"><a href=\"#cite_note-:1-3\">(3)<\/a><\/sup><\/p>\n<ul>\n<li>La litt\u00e9rature indique que 67 % des personnes atteintes d&rsquo;une l\u00e9sion de la moelle \u00e9pini\u00e8re pr\u00e9sentent des <a title=\"Respiratory Failure\" href=\"\/Respiratory_Failure\">complications respiratoires<\/a> en stade aigu. <sup id=\"cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\">(4)<\/a><\/sup><\/li>\n<\/ul>\n<p>Une revue r\u00e9trospective (d\u00e9c. 2020) des patients ayant subi une l\u00e9sion traumatique aigu\u00eb de la moelle \u00e9pini\u00e8re au niveau C5 \u00e0 T5 au cours de la p\u00e9riode 2010-2015 montre une pr\u00e9valence plus \u00e9lev\u00e9e de complications respiratoires au cours de l&rsquo;hospitalisation initiale juste apr\u00e8s la l\u00e9sion et sugg\u00e8re que la pr\u00e9sence d&rsquo;ant\u00e9c\u00e9dents de <a title=\"Respiratory Disorders\" href=\"\/Respiratory_Disorders\">maladie respiratoire<\/a>, handicap moteur complet (<a title=\"American Spinal Cord Injury Association (ASIA) Impairment Scale\" href=\"\/American_Spinal_Cord_Injury_Association_(ASIA)_Impairment_Scale\">AISA A-B<\/a>) et traumatisme thoracique coexistant sont un facteur pr\u00e9dictif de complications respiratoires. Les personnes souffrant de l\u00e9sions de la moelle \u00e9pini\u00e8re cervicale et thoracique sup\u00e9rieure sont plus susceptibles de d\u00e9velopper des complications respiratoires, principalement en raison de l&rsquo;atteinte du <a class=\"external text\" href=\"https:\/\/www.physio-pedia.com\/Muscles_of_Respiration\" rel=\"nofollow\">diaphragme<\/a>. <sup id=\"cite_ref-:0_1-1\" class=\"reference\"><a href=\"#cite_note-:0-1\">(1)<\/a><\/sup><\/p>\n<ul>\n<li>Le diaphragme est responsable de 65 % de la capacit\u00e9 vitale forc\u00e9e et joue un r\u00f4le important dans la ventilation.<sup id=\"cite_ref-:1_3-1\" class=\"reference\"><a href=\"#cite_note-:1-3\">(3)<\/a><\/sup><\/li>\n<li>Une ventilation normale est possible gr\u00e2ce \u00e0 l&rsquo;effort coordonn\u00e9 de nombreux syst\u00e8mes, principalement : musculo-squelettique, neuromusculaire et t\u00e9gumentaire.<\/li>\n<\/ul>\n<p>L&rsquo;identification pr\u00e9coce des patients souffrant d&rsquo;une l\u00e9sion de la moelle \u00e9pini\u00e8re et pr\u00e9sentant un risque de complications respiratoires pourrait aider les cliniciens \u00e0 mettre en \u0153uvre des strat\u00e9gies pr\u00e9ventives pour r\u00e9duire les complications. <sup id=\"cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\">(5)<\/a><\/sup><\/p>\n<h2><span id=\"Normal_Respiration\" class=\"mw-headline\">Respiration normale <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Normal Respiration\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=2\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Normal Respiration\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=2\">source d&rsquo;\u00e9dition<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Diaphragmatic_breathing.gif\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/9\/9c\/Diaphragmatic_breathing.gif\/300px-Diaphragmatic_breathing.gif\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/9\/9c\/Diaphragmatic_breathing.gif\/450px-Diaphragmatic_breathing.gif 1.5x, https:\/\/www.physio-pedia.com\/images\/9\/9c\/Diaphragmatic_breathing.gif 2x\" alt=\"\" width=\"300\" height=\"218\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Respiration diaphragmatique<\/p>\n<\/div>\n<\/div>\n<\/div>\n<p>Afin de comprendre comment le fonctionnement respiratoire est affect\u00e9 chez les personnes atteintes d&rsquo;une l\u00e9sion de la moelle \u00e9pini\u00e8re, il est important de comprendre comment se d\u00e9roule la respiration normale. La s\u00e9quence d&rsquo;une inspiration normale comprend d&rsquo;abord le soul\u00e8vement de la partie sup\u00e9rieure de l&rsquo;abdomen, suivi de l&rsquo;expansion lat\u00e9rale de la partie inf\u00e9rieure du thorax, puis d&rsquo;un l\u00e9ger soul\u00e8vement de la partie sup\u00e9rieure du thorax dans deux plans : sup\u00e9rieur et ant\u00e9rieur. Une autre mesure de la respiration normale est le nombre de syllabes par respir. Au cours d&rsquo;une conversation normale, une personne adulte produit habituellement environ 16,55 syllabes par respir.<\/p>\n<p>La ventilation normale est possible gr\u00e2ce \u00e0 l&rsquo;effort coordonn\u00e9 des nombreux syst\u00e8mes impliqu\u00e9s. Les principaux syst\u00e8mes impliqu\u00e9s dans la respiration normale sont les suivants :<\/p>\n<ul>\n<li>Musculo-squelettique<\/li>\n<li>Neuromusculaire<\/li>\n<\/ul>\n<ul>\n<li><a title=\"Integumentary System\" href=\"\/Integumentary_System\">T\u00e9gumentaire<\/a><\/li>\n<li>Autres (organes internes)<\/li>\n<\/ul>\n<h3><span id=\"Musculoskeletal\" class=\"mw-headline\">Musculo-squelettique<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Musculoskeletal\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=3\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Musculoskeletal\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=3\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Le soutien <b>squelettique<\/b> de la ventilation comprend :<\/p>\n<ol>\n<li>Ant\u00e9rieurement : <a title=\"Ribs\" href=\"\/Ribs\">lesc\u00f4tes<\/a> et <a title=\"Sternum\" href=\"\/Sternum\">le sternum<\/a><\/li>\n<li>En arri\u00e8re : <a title=\"Thoracic Anatomy\" href=\"\/Thoracic_Anatomy\">colonne thoracique<\/a> et c\u00f4tes post\u00e9rieures.<\/li>\n<\/ol>\n<p>Pendant l&rsquo;inspiration, les c\u00f4tes sup\u00e9rieures se d\u00e9placent principalement dans une direction ant\u00e9rieure et sup\u00e9rieure, les c\u00f4tes moyennes se d\u00e9placent dans les trois plans de mouvement (ant\u00e9rieur, sup\u00e9rieur et lat\u00e9ral), et les c\u00f4tes inf\u00e9rieures se d\u00e9placent principalement dans une direction lat\u00e9rale et sup\u00e9rieure. La plus grande mobilit\u00e9 de la cage thoracique se produit le long de l&rsquo;apophyse xipho\u00efde et des bords inf\u00e9rieurs des c\u00f4tes ant\u00e9rieures et lat\u00e9rales. La colonne thoracique permet de soutenir l&rsquo;alignement m\u00e9canique de la cage thoracique.<\/p>\n<p>Rappelez-vous : C3, C4, C5 nous maintiennent en vie !<\/p>\n<div class=\"floatright\"><a class=\"image\" href=\"\/File:949_937_muscles-of-respiration.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/e\/e7\/949_937_muscles-of-respiration.jpg\/469px-949_937_muscles-of-respiration.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/e\/e7\/949_937_muscles-of-respiration.jpg 1.5x\" alt=\"949 937 muscles-of-respiration.jpg\" width=\"469\" height=\"333\"><\/a><\/div>\n<p>Les <b>muscles primaires de<\/b> la ventilation :<\/p>\n<ol>\n<li><a title=\"L'anatomie du diaphragme et le diagnostic diff\u00e9rentiel\" href=\"\/Diaphragm_Anatomy_and_Differential_Diagnosis\">Diaphragme<\/a>: innerv\u00e9 par le nerf phr\u00e9nique C3-C5. Le diaphragme fournit jusqu&rsquo;\u00e0 75 % de l&rsquo;effort li\u00e9 au volume courant. Il se d\u00e9place dans les trois plans et sa fonction d\u00e9pend de celle des muscles intercostaux et abdominaux, des cordes vocales et des <a title=\"Pelvic Floor Anatomy\" href=\"\/Pelvic_Floor_Anatomy\">muscles du plancher pelvien<\/a>. Pendant une inspiration calme et puissante, le diaphragme se contracte de mani\u00e8re concentrique. L&rsquo;expiration contr\u00f4l\u00e9e n\u00e9cessite une contraction excentrique du diaphragme.<\/li>\n<li>Intercostaux : innerv\u00e9s par les niveaux T1-T11. Dans leur r\u00f4le principal, les intercostaux stabilisent la cage thoracique pendant l&rsquo;inspiration et aident \u00e0 la d\u00e9pression des c\u00f4tes pendant l&rsquo;expiration forc\u00e9e. De plus, les intercostaux externes \u00e9l\u00e8vent les c\u00f4tes pendant l&rsquo;inspiration forc\u00e9e. Lors d&rsquo;une inspiration et d&rsquo;une expiration calme et puissante, les intercostaux se contractent de mani\u00e8re concentrique lorsque l&rsquo;expiration contr\u00f4l\u00e9e exige une contraction excentrique. Remarque : un patient souffrant d&rsquo;une l\u00e9sion de la moelle \u00e9pini\u00e8re qui a un tube de <a title=\"Tracheostomy\" href=\"\/Tracheostomy\">trach\u00e9otomie<\/a>, mais qui n&rsquo;est pas en mesure de tol\u00e9rer une valve parlante, ne peut pas compter sur cette contraction excentrique pour am\u00e9liorer la ventilation, car le tube de trach\u00e9otomie permet \u00e0 l&rsquo;air de s&rsquo;\u00e9chapper \u00e0 volont\u00e9. <sup id=\"cite_ref-:5_6-0\" class=\"reference\"><a href=\"#cite_note-:5-6\">(6)<\/a><\/sup><\/li>\n<li><a title=\"Abdominal Muscles\" href=\"\/Abdominal_Muscles\">Abdominaux<\/a>: innerv\u00e9s par les niveaux T6 \u00e0 L1. Le r\u00f4le principal des <a title=\"Internal Abdominal Oblique\" href=\"\/Internal_Abdominal_Oblique\">obliques internes<\/a> est d&rsquo;aider \u00e0 la traction vers le bas du bord inf\u00e9rieur de la cage thoracique. Les <a title=\"External Abdominal Oblique\" href=\"\/External_Abdominal_Oblique\">obliques externes<\/a> stabilisent le bord inf\u00e9rieur de la cage thoracique. Le <a title=\"Transversus Abdominis\" href=\"\/Transversus_Abdominis\">transverse de l&rsquo;abdomen<\/a> aide le diaphragme \u00e0 maintenir une pression positive.<\/li>\n<\/ol>\n<p>Regardez cette animation de 2 minutes sur les m\u00e9canismes de la respiration.<\/p>\n<div class=\"thumb embedvideo autoResize\" style=\"width: 648px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 640px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/MPovpAXcmIU?\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\">(7)<\/a><\/sup><\/p>\n<p><b>Muscles accessoires<\/b> de la ventilation :<\/p>\n<ol>\n<li>Paraspinaux (<a title=\"Erector Spinae\" href=\"\/Erector_Spinae\">Erector spinae<\/a>) : Innervation T1-S3, fournissent une stabilisation post\u00e9rieure du thorax permettant une expansion ant\u00e9rieure de la poitrine.<\/li>\n<li>Muscles <a title=\"Pectoralis major\" href=\"\/Pectoralis_major\">grand<\/a> et <a title=\"Pectoralis Minor\" href=\"\/Pectoralis_Minor\">petit pectoraux<\/a>: Innervation C5-T1, assurent le mouvement du haut du thorax dans 2 plans : ant\u00e9rieur et lat\u00e9ral. Ils agissent comme des stabilisateurs de c\u00f4tes lorsque les muscles intercostaux sont paralys\u00e9s.<\/li>\n<li><a title=\"Serratus Anterior\" href=\"\/Serratus_Anterior\">Grand dentel\u00e9 <\/a>: Innervation C5-C7, avec extr\u00e9mit\u00e9 sup\u00e9rieure fixe &#8211; aide \u00e0 l&rsquo;expansion post\u00e9rieure de la cage thoracique. C&rsquo;est le seul muscle inspiratoire qui associe sa fonction \u00e0 la flexion du tronc.<\/li>\n<li><a title=\"Scalene\" href=\"\/Scalene\">Scal\u00e8nes <\/a>: Innervation C3-C8, permettent le mouvement sup\u00e9rieur et ant\u00e9rieur de la partie sup\u00e9rieure du thorax.<\/li>\n<li><a title=\"Sternocleidomastoid\" href=\"\/Sternocleidomastoid\">Sternocleidomasto\u00efdien <\/a>: Innervation C2-C3 et <a title=\"Cranial Nerves\" href=\"\/Cranial_Nerves\">nerf cr\u00e2nien<\/a> accessoire, permettent le mouvement sup\u00e9rieur et ant\u00e9rieur de la partie sup\u00e9rieure du thorax.<\/li>\n<li><a title=\"Trapezius\" href=\"\/Trapezius\">Trap\u00e8ze <\/a>: Innervation de C2-C4, permet un mouvement sup\u00e9rieur de la partie sup\u00e9rieure de la poitrine. Il doit soulever le poids du membre sup\u00e9rieur pour aider \u00e0 la ventilation et c&rsquo;est un muscle tr\u00e8s inefficace.<\/li>\n<\/ol>\n<h3><span id=\"Neuromuscular\" class=\"mw-headline\">Neuromusculaire<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Neuromuscular\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=4\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Neuromuscular\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=4\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Le syst\u00e8me neuro-respiratoire comprend le <a title=\"Cerebral Cortex\" href=\"\/Cerebral_Cortex\">cortex<\/a> du <a title=\"Brain Anatomy\" href=\"\/Brain_Anatomy\">cerveau<\/a> responsable du contr\u00f4le de la respiration volontaire et le <a title=\"Brainstem\" href=\"\/Brainstem\">tronc c\u00e9r\u00e9bral<\/a> qui contr\u00f4le la respiration automatique. La moelle \u00e9pini\u00e8re et les <a title=\"Motor Neurone\" href=\"\/Motor_Neurone\">neurones moteurs <\/a>sont \u00e9galement des \u00e9l\u00e9ments de ce syst\u00e8me et sont responsables de la transmission des impulsions <a title=\"Neurone\" href=\"\/Neurone\">nerveuses<\/a> aux muscles respiratoires, fermant ainsi la boucle de l&rsquo;action de la respiration. Il existe \u00e9galement un syst\u00e8me de r\u00e9cepteurs et de nerfs qui r\u00e9gulent le processus de la ventilation.<sup id=\"cite_ref-:3_8-0\" class=\"reference\"><a href=\"#cite_note-:3-8\">(8)<\/a><\/sup><\/p>\n<p>Cette vid\u00e9o traite du contr\u00f4le neuromusculaire de la respiration.<\/p>\n<div class=\"thumb embedvideo autoResize\" style=\"width: 308px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 300px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/GqkMzds77f8?\" width=\"300\" height=\"169\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\">(9)<\/a><\/sup><\/p>\n<h3><span id=\"Integumentary_(Skin)\"><\/span><span id=\"Integumentary_.28Skin.29\" class=\"mw-headline\">T\u00e9gumentaire (peau) <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Integumentary (Skin)\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=5\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Integumentary (Skin)\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=5\">source d&rsquo;\u00e9dition<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>La perte de la qualit\u00e9 \u00e9lastique de la <a title=\"La peau\" href=\"\/Skin\">peau<\/a> peut entra\u00eener un dysfonctionnement plus profond affectant la colonne vert\u00e9brale et la mobilit\u00e9 de la cage thoracique. Les cicatrices et les adh\u00e9rences se forment \u00e0 la suite d&rsquo;une maladie inflammatoire, de <a title=\"Burns Overview\" href=\"\/Burns_Overview\">br\u00fblures<\/a>, d&rsquo;un <a title=\"Trauma-Informed Care\" href=\"\/Trauma-Informed_Care\">traumatisme<\/a> ou d&rsquo;une incision chirurgicale et peuvent affecter la qualit\u00e9 des tissus et leur flexibilit\u00e9. Les adh\u00e9rences entre l&rsquo;\u00e9piderme, le derme et le fascia ne s&rsquo;arr\u00eatent pas seulement \u00e0 leur niveau. En raison de la continuit\u00e9 du tissu conjonctif dans tout le corps, les restrictions superficielles peuvent s&rsquo;\u00e9tendre plus profond\u00e9ment, limitant la mobilit\u00e9 de l&rsquo;ensemble du syst\u00e8me musculo-squelettique, y compris les <a title=\"Les fascias\" href=\"\/Fascia\">fascias<\/a>, les <a title=\"Tendon Anatomy\" href=\"\/Tendon_Anatomy\">tendons<\/a>, les <a title=\"Muscle\" href=\"\/Muscle\">muscles<\/a> et les articulations. Une \u00e9tude montre qu&rsquo;une mobilit\u00e9 limit\u00e9e de la paroi abdominale, ainsi que de la partie sup\u00e9rieure et inf\u00e9rieure du thorax, est en corr\u00e9lation avec une fonction pulmonaire affaiblie.<sup id=\"cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\">(10)<\/a><\/sup><\/p>\n<h2><span id=\"Spinal_Cord_Injury_and_Respiration\" class=\"mw-headline\">L\u00e9sion de la moelle \u00e9pini\u00e8re et respiration <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Spinal Cord Injury and Respiration\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=6\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Spinal Cord Injury and Respiration\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=6\">source d&rsquo;\u00e9dition<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>Les l\u00e9sions traumatiques et non traumatiques (tumeur, accident vasculaire, abc\u00e8s, my\u00e9lite transverse) de la colonne vert\u00e9brale peuvent affecter la respiration en raison d&rsquo;une alt\u00e9ration du contr\u00f4le moteur des muscles respiratoires. Une <a title=\"Ventilation and Weaning\" href=\"\/Ventilation_and_Weaning\">ventilation<\/a> \u00e0 long terme peut \u00eatre n\u00e9cessaire en cas de l\u00e9sion de la moelle \u00e9pini\u00e8re au niveau des hautes cervicales (C3 et plus). Les l\u00e9sions inf\u00e9rieures \u00e0 C3 peuvent n\u00e9cessiter ou non une assistance respiratoire, tandis que les patients pr\u00e9sentant des l\u00e9sions inf\u00e9rieures \u00e0 C5 peuvent \u00eatre capables de respirer ind\u00e9pendamment d&rsquo;une assistance respiratoire continue.<sup id=\"cite_ref-:3_8-1\" class=\"reference\"><a href=\"#cite_note-:3-8\">(8)<\/a><\/sup><\/p>\n<p>Le tableau suivant illustre le niveau de l&rsquo;atteinte neurologique correspondant \u00e0 la d\u00e9ficience : <sup id=\"cite_ref-:0_1-2\" class=\"reference\"><a href=\"#cite_note-:0-1\">(1)<\/a><\/sup><sup id=\"cite_ref-:2_2-1\" class=\"reference\"><a href=\"#cite_note-:2-2\">(2)<\/a><\/sup><\/p>\n<table class=\"wikitable\">\n<tbody>\n<tr>\n<th>Niveau neurologique<\/th>\n<th>D\u00e9ficience<\/th>\n<\/tr>\n<tr>\n<td>C1-3<\/td>\n<td>Enti\u00e8rement d\u00e9pendant d&rsquo;un ventilateur<\/td>\n<\/tr>\n<tr>\n<td>C3-4<\/td>\n<td>P\u00e9riodes de ventilation non assist\u00e9e<\/p>\n<p>Diaphragme alt\u00e9r\u00e9 &#8211; \u2193 volume courant et capacit\u00e9 vitale<\/td>\n<\/tr>\n<tr>\n<td>C5<\/td>\n<td>Ventilation ind\u00e9pendante<\/p>\n<p>Assistance ventilatoire initiale<\/p>\n<p>Diaphragme intact<\/p>\n<p>Les muscles intercostaux et abdominaux sont alt\u00e9r\u00e9s &#8211; \u2193 volumes pulmonaires et expiration forc\u00e9e pour l&rsquo;\u00e9vacuation efficace des s\u00e9cr\u00e9tions.<\/td>\n<\/tr>\n<tr>\n<td>C6-8<\/td>\n<td>Ventilation ind\u00e9pendante<\/p>\n<p>Diaphragme intact<\/p>\n<p>Les muscles intercostaux et abdominaux sont alt\u00e9r\u00e9s &#8211; \u2193 volumes pulmonaires et expiration forc\u00e9e pour l&rsquo;\u00e9vacuation efficace des s\u00e9cr\u00e9tions.<\/p>\n<p>Utilise les muscles accessoires pour g\u00e9n\u00e9rer une toux efficace.<\/td>\n<\/tr>\n<tr>\n<td>T1-4<\/td>\n<td>Ventilation ind\u00e9pendante<\/p>\n<p>Diaphragme intact<\/p>\n<p>Intercostaux intacts &#8211; volumes pulmonaires normaux<\/p>\n<p>Muscles abdominaux alt\u00e9r\u00e9s &#8211; \u2193 expiration forc\u00e9e pour l&rsquo;\u00e9vacuation efficace des s\u00e9cr\u00e9tions.<\/td>\n<\/tr>\n<tr>\n<td>T5-12<\/td>\n<td>Ventilation presque \u00e9gale ou \u00e9gale \u00e0 celle des personnes sans l\u00e9sion de la moelle \u00e9pini\u00e8re.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><sup id=\"cite_ref-:2_2-2\" class=\"reference\"><a href=\"#cite_note-:2-2\">(2)<\/a><\/sup><\/p>\n<h3><span id=\"Respiratory_Complications\" class=\"mw-headline\">Complications respiratoires <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Respiratory Complications\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=7\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Respiratory Complications\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=7\">source d&rsquo;\u00e9dition<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Le type et l&rsquo;\u00e9tendue des complications respiratoires d\u00e9pendent du niveau de la blessure et du degr\u00e9 de d\u00e9ficience. Elles peuvent affecter 80 % des patients souffrant d&rsquo;une l\u00e9sion de la moelle \u00e9pini\u00e8re pendant l&rsquo;hospitalisation en aigu et se poursuivent pendant les phases post-aigu\u00eb et chronique de la r\u00e9adaptation des l\u00e9sions de la moelle \u00e9pini\u00e8re.<sup id=\"cite_ref-:4_11-0\" class=\"reference\"><a href=\"#cite_note-:4-11\">(11)<\/a><\/sup> Les complications possibles incluent les suivantes :<\/p>\n<ul>\n<li>Hypoventilation<\/li>\n<li>R\u00e9duction de la production de tensioactifs<\/li>\n<li><a title=\"Respiratory Failure\" href=\"\/Respiratory_Failure\">Insuffisance respiratoire <\/a><sup id=\"cite_ref-:4_11-1\" class=\"reference\"><a href=\"#cite_note-:4-11\">(11)<\/a><\/sup><\/li>\n<li>Bouchon de mucus<\/li>\n<li><a title=\"Atelectasie\" href=\"\/Atelectasis\">Atelectasie<\/a><\/li>\n<li><a title=\"Pneumonie\" href=\"\/Pneumonia\">Pneumonie <\/a><sup id=\"cite_ref-:4_11-2\" class=\"reference\"><a href=\"#cite_note-:4-11\">(11)<\/a><\/sup><sup id=\"cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\">(12)<\/a><\/sup><\/li>\n<li><a title=\"Pulmonary Oedema\" href=\"\/Pulmonary_Oedema\">\u0152d\u00e8me pulmonaire<\/a><\/li>\n<li><a title=\"Pulmonary Embolism\" href=\"\/Pulmonary_Embolism\">Embolie pulmonaire<\/a><\/li>\n<li><a title=\"Sleep Apnea\" href=\"\/Sleep_Apnea\">Troubles respiratoires du sommeil et syndrome d&rsquo;apn\u00e9e du sommeil <\/a> <sup id=\"cite_ref-:0_1-3\" class=\"reference\"><a href=\"#cite_note-:0-1\">(1)<\/a><\/sup><sup id=\"cite_ref-:2_2-3\" class=\"reference\"><a href=\"#cite_note-:2-2\">(2)<\/a><\/sup><\/li>\n<\/ul>\n<p>Les probl\u00e8mes de ventilation et les complications respiratoires \u00e9num\u00e9r\u00e9es ci-dessus chez les personnes atteintes d&rsquo;une l\u00e9sion de la moelle \u00e9pini\u00e8re peuvent \u00eatre li\u00e9s aux conditions suivantes :<\/p>\n<ul>\n<li>Difficult\u00e9s cr\u00e9\u00e9es par la toux productive et de l&rsquo;\u00e9vacuation des s\u00e9cr\u00e9tions<\/li>\n<li>Production excessive de mucus<\/li>\n<li>Contraction spastique des muscles abdominaux<\/li>\n<li>Restrictions dans les positions et limitations de la mobilit\u00e9<\/li>\n<\/ul>\n<h4><span id=\"Cough_and_Secretions\" class=\"mw-headline\">Toux et s\u00e9cr\u00e9tions <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Cough and Secretions\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=8\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Cough and Secretions\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=8\">modifier la source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Des difficult\u00e9s \u00e0 tousser et \u00e0 \u00e9vacuer les s\u00e9cr\u00e9tions peuvent \u00eatre observ\u00e9es chez les patients souffrant de l\u00e9sions de la colonne cervicale, thoracique et lombaire haute. Ces deux fonctions d\u00e9pendent de l&rsquo;engagement des <a title=\"Muscles of Respiration\" href=\"\/Muscles_of_Respiration\">muscles intercostaux<\/a> et <a title=\"Muscles of Respiration\" href=\"\/Muscles_of_Respiration\">abdominaux<\/a> (innerv\u00e9s aux niveaux T1-L1).<\/p>\n<h4><span id=\"Mucus_Production\" class=\"mw-headline\">Production de mucus <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Mucus Production\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=9\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Mucus Production\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=9\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Une autre complication fr\u00e9quente chez les patients quadripl\u00e9giques est la production excessive de mucus bronchique. La cause de ce ph\u00e9nom\u00e8ne est encore incertaine, mais on pense que cette surproduction de mucus bronchique est d\u00fbe \u00e0 une r\u00e9duction de l&rsquo;activit\u00e9 du nerf <a title=\"Vagus Nerve\" href=\"\/Vagus_Nerve\">vagal<\/a>, qui entra\u00eene un d\u00e9s\u00e9quilibre <a title=\"Parasympathetic System\" href=\"\/Parasympathetic_System\">parasympathique<\/a> causant :<\/p>\n<ul>\n<li>Un spasme bronchique<\/li>\n<li>Une augmentation de la congestion vasculaire<\/li>\n<li>Une diminution de l&rsquo;activit\u00e9 mucociliaire (li\u00e9e \u00e0 la ventilation m\u00e9canique) <sup id=\"cite_ref-:0_1-4\" class=\"reference\"><a href=\"#cite_note-:0-1\">(1)<\/a><\/sup><\/li>\n<\/ul>\n<h4><span id=\"Spastic_Contraction_of_Abdominal_Muscles\" class=\"mw-headline\">Contraction spastique des muscles abdominaux <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Spastic Contraction of Abdominal Muscles\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=10\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Spastic Contraction of Abdominal Muscles\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=10\">source d&rsquo;\u00e9dition<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Apr\u00e8s la <a title=\"Spinal Shock\" href=\"\/Spinal_Shock\">phase de choc spinal<\/a>, des <a title=\"Reflexes\" href=\"\/Reflexes\">r\u00e9flexes<\/a> spinaux anormaux peuvent entra\u00eener une contraction spastique des muscles abdominaux. Cela peut accro\u00eetre les difficult\u00e9s respiratoires et entra\u00eener une <a title=\"Dyspnoea\" href=\"\/Dyspnoea\">dyspn\u00e9e. <\/a><sup id=\"cite_ref-:0_1-5\" class=\"reference\"><a href=\"#cite_note-:0-1\">(1)<\/a><\/sup><\/p>\n<h4><span id=\"Position_and_Orthoses\" class=\"mw-headline\">Position et orth\u00e8ses <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Position and Orthoses\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=11\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Position and Orthoses\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=11\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Les positions redress\u00e9es peuvent avoir un effet n\u00e9gatif sur la ventilation en raison de l&rsquo;aplatissement du diaphragme et du d\u00e9placement vers l&rsquo;avant du contenu abdominal d\u00fb \u00e0 la faiblesse des muscles abdominaux. Le port d&rsquo;une bande de soutien abdominale peut faciliter la respiration en position debout.<sup id=\"cite_ref-:0_1-6\" class=\"reference\"><a href=\"#cite_note-:0-1\">(1)<\/a><\/sup><\/p>\n<h2><span id=\"Acute_Respiratory_Management\" class=\"mw-headline\">Prise en charge respiratoire en aigu <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Acute Respiratory Management\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=12\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Acute Respiratory Management\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=12\">source d&rsquo;\u00e9dition<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>Le r\u00f4le des membres de l&rsquo;\u00e9quipe multidisciplinaire varie dans de nombreux aspects de la prise en charge respiratoire des patients atteints d&rsquo;une l\u00e9sion de la moelle \u00e9pini\u00e8re. Il d\u00e9pend souvent des politiques et proc\u00e9dures \u00e9tablies par les organisations professionnelles de chaque pays.<\/p>\n<h3><span id=\"Monitoring\" class=\"mw-headline\">Surveillance<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Monitoring\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=13\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Monitoring\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=13\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Pendant la phase aigu\u00eb d&rsquo;une l\u00e9sion de la moelle \u00e9pini\u00e8re, l&rsquo;ensemble de l&rsquo;\u00e9quipe m\u00e9dicale peut \u00eatre charg\u00e9e de surveiller les \u00e9l\u00e9ments suivants :<\/p>\n<ul>\n<li>Fonction diaphragmatique<\/li>\n<li><a title=\"Pulse Oximeter\" href=\"\/Pulse_Oximeter\">Oxym\u00e9trie du pouls<\/a><\/li>\n<li><a title=\"Arterial Blood Gases\" href=\"\/Arterial_Blood_Gases\">Gazom\u00e9trie art\u00e9rielle<\/a><\/li>\n<\/ul>\n<p>Ces marqueurs indiquent un besoin d&rsquo;intuber le patient :<\/p>\n<ul>\n<li>Capacit\u00e9 vitale inf\u00e9rieure \u00e0 15mL\/kg<\/li>\n<li>Pression inspiratoire maximale inf\u00e9rieure \u00e0 -20cmH2O<\/li>\n<li>Augmentation de la pCO2<sup id=\"cite_ref-:2_2-4\" class=\"reference\"><a href=\"#cite_note-:2-2\">(2)<\/a><\/sup><\/li>\n<\/ul>\n<h3><span id=\"Ventilation,_Weaning_and_Extubation\"><\/span><span id=\"Ventilation.2C_Weaning_and_Extubation\" class=\"mw-headline\">Ventilation, sevrage et extubation <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Ventilation, Weaning and Extubation\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=14\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Ventilation, Weaning and Extubation\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=14\">source d&rsquo;\u00e9dition<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>L&rsquo;\u00e9quipe m\u00e9dicale, compos\u00e9e du neurologue, de l&rsquo;anesth\u00e9siste, de l&rsquo;inhaloth\u00e9rapeute, de l&rsquo;infirmi\u00e8re et du physioth\u00e9rapeute, d\u00e9cide des param\u00e8tres de ventilation pour r\u00e9pondre aux besoins respiratoires sp\u00e9cifiques de chaque personne atteinte d&rsquo;une l\u00e9sion de la moelle \u00e9pini\u00e8re. La <a class=\"mw-redirect\" title=\"Chest Physiotherapy\" href=\"\/Chest_Physiotherapy\">physioth\u00e9rapie thoracique<\/a> effectu\u00e9e par l&rsquo;inhaloth\u00e9rapeute, l&rsquo;infirmi\u00e8re et\/ou le physioth\u00e9rapeute est un \u00e9l\u00e9ment cl\u00e9 de la proc\u00e9dure post-extubation.<\/p>\n<h3><span id=\"Tracheostomy_and_Decannulation\" class=\"mw-headline\">Trach\u00e9otomie et d\u00e9canulation <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Tracheostomy and Decannulation\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=15\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Tracheostomy and Decannulation\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=15\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Les personnes atteintes d&rsquo;une l\u00e9sion de la moelle \u00e9pini\u00e8re qui d\u00e9veloppent des complications respiratoires ou qui pr\u00e9sentent un niveau \u00e9lev\u00e9 de l\u00e9sion compl\u00e8te de la moelle \u00e9pini\u00e8re sont susceptibles de recevoir une trach\u00e9otomie. Lorsque la d\u00e9cannulation est envisag\u00e9e, il est important que l&rsquo;ensemble de l&rsquo;\u00e9quipe multidisciplinaire \u00e9value la perm\u00e9abilit\u00e9 des voies a\u00e9riennes, l&rsquo;efficacit\u00e9 de la toux et de la d\u00e9glutition ainsi que les besoins en oxyg\u00e8ne, la stabilit\u00e9 m\u00e9dicale, la coop\u00e9ration du patient, la d\u00e9pendance \u00e0 l&rsquo;oxyg\u00e8ne et les marqueurs d&rsquo;infection. <sup id=\"cite_ref-:0_1-7\" class=\"reference\"><a href=\"#cite_note-:0-1\">(1)<\/a><\/sup><sup id=\"cite_ref-:2_2-5\" class=\"reference\"><a href=\"#cite_note-:2-2\">(2)<\/a><\/sup><\/p>\n<h2><span id=\"Physiotherapy_Management_of_Respiration\" class=\"mw-headline\">Traitement de la respiration par la physioth\u00e9rapie <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Physiotherapy Management of Respiration\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=16\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Physiotherapy Management of Respiration\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=16\">source d&rsquo;\u00e9dition<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<h3><span id=\"Patient_Assessment(6)\"><\/span><span id=\"Patient_Assessment.5B6.5D\" class=\"mw-headline\">\u00c9valuation du patient <sup id=\"cite_ref-:5_6-1\" class=\"reference\"><a href=\"#cite_note-:5-6\">(6) <\/a><\/sup><\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Patient Assessment(6)\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=17\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Patient Assessment(6)\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=17\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<ul>\n<li>Observation et palpation\n<ul>\n<li>Observer et palper les sch\u00e9mas respiratoires en regardant le thorax en vue ant\u00e9rieure et post\u00e9rieure (expansion du thorax sup\u00e9rieur, moyen et inf\u00e9rieur)<\/li>\n<li>Observer et palper l&rsquo;alignement des muscles du tronc, notamment le cou et l&rsquo;\u00e9paule, les intercostaux, les pectoraux, les abdominaux, le carr\u00e9 des lombes et les muscles post\u00e9rieurs du tronc. Surveillez les tensions, la fonction pendant l&rsquo;inspiration et l&rsquo;expiration, la fonction lorsque le patient l\u00e8ve la t\u00eate ou tente de se lever du lit<\/li>\n<li>Observer l&rsquo;espacement et la fonction des c\u00f4tes : flexion lat\u00e9rale, s\u00e9paration des c\u00f4tes, sym\u00e9trie dans des situations statiques et dynamiques<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Mesure objective\n<ul>\n<li>Mesure de l&rsquo;excursion de la paroi thoracique \u00e0 l&rsquo;aide d&rsquo;un ruban \u00e0 mesurer<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>\u00c9coute\n<ul>\n<li><a title=\"Auscultation\" href=\"\/Auscultation\">Auscultation<\/a> des bruits respiratoires<\/li>\n<li>Noter la qualit\u00e9 de la phonation, inclant les syllabes par respir et les changements dans la voix<\/li>\n<li>Noter l&rsquo;efficacit\u00e9 de la toux dans chacune de ses quatre phases : phase d&rsquo;inspiration, phase de maintien, phase de force et phase d&rsquo;expulsion<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>D\u00e9terminer le probl\u00e8me et choisir le plan d&rsquo;action : le probl\u00e8me peut concerner la mobilisation des s\u00e9cr\u00e9tions (des poumons vers le haut), l&rsquo;expectoration des s\u00e9cr\u00e9tions (des voies a\u00e9riennes inf\u00e9rieures vers le haut) ou la gestion des s\u00e9cr\u00e9tions (s&rsquo;\u00e9loigner de la trach\u00e9e pour \u00e9viter l&rsquo;aspiration)<\/li>\n<\/ul>\n<h3><span id=\"Positioning\" class=\"mw-headline\">Le positionnement<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Positioning\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=18\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Positioning\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=18\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Pour les personnes dont le syst\u00e8me respiratoire est compromis, un positionnement ad\u00e9quat est essentiel pour influencer les sch\u00e9mas respiratoires et am\u00e9liorer la ventilation. Une personne atteinte d&rsquo;une l\u00e9sion de la moelle \u00e9pini\u00e8re peut avoir besoin de s&rsquo;appuyer sur des muscles accessoires pour respirer, notamment sur le recrutement des muscles du tronc pour l&rsquo;inspiration et l&rsquo;expiration. Lorsque les muscles du tronc sont trop faibles pour soutenir une position assise droite, une assise et un positionnement appropri\u00e9s au fauteuil roulant sont n\u00e9cessaires pour optimiser la respiration et faciliter l&rsquo;utilisation des muscles accessoires.<sup id=\"cite_ref-:6_13-0\" class=\"reference\"><a href=\"#cite_note-:6-13\">(13)<\/a><\/sup><\/p>\n<ul>\n<li>Crytzer et al. <sup id=\"cite_ref-:6_13-1\" class=\"reference\"><a href=\"#cite_note-:6-13\">(13)<\/a><\/sup> ont sugg\u00e9r\u00e9 un support dorsal avec des cellules d&rsquo;air \u00e0 l&rsquo;int\u00e9rieur sur un dossier rigide. Les cellules d&rsquo;air permettent l&rsquo;expansion du tronc et de la cage thoracique. <sup id=\"cite_ref-:6_13-2\" class=\"reference\"><a href=\"#cite_note-:6-13\">(13)<\/a><\/sup><\/li>\n<li>Le support dorsal doit s&rsquo;adapter \u00e0 chaque personne pour optimiser la posture et la fonction.<sup id=\"cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\">(14)<\/a><\/sup><\/li>\n<li>Le r\u00e9glage du repose-pieds peut faciliter la respiration de la partie sup\u00e9rieure de la poitrine ou du diaphragme : un appui inf\u00e9rieur du pied favorise l&rsquo;<a title=\"Pelvic Tilt\" href=\"\/Pelvic_Tilt\">inclinaison ant\u00e9rieure du bassin<\/a>, encourageant la respiration de la partie sup\u00e9rieure de la poitrine, tandis qu&rsquo;un appui sup\u00e9rieur du pied favorise l&rsquo;inclinaison post\u00e9rieure du bassin, encourageant la respiration du diaphragme. <sup id=\"cite_ref-:5_6-2\" class=\"reference\"><a href=\"#cite_note-:5-6\">(6)<\/a><\/sup><\/li>\n<li>Accoudoirs et support de la main et du bras vs plateau de laboratoire : les accoudoirs et les supports de la main et du bras permettent de positionner les membres sup\u00e9rieurs en abduction et rotation externe (respiration thoracique sup\u00e9rieure) et le plateau de laboratoire aide \u00e0 positionner les membres sup\u00e9rieurs en adduction et rotation interne (respiration diaphragmatique).<\/li>\n<li>Placer un rouleau de serviette \u00e0 l&rsquo;horizontale (sous l&rsquo;<a title=\"Ischium\" href=\"\/Ischium\">ischion<\/a>) ou dans une direction perpendiculaire (le long de la colonne vert\u00e9brale) ouvre la paroi thoracique ant\u00e9rieure et facilite la respiration du haut du thorax.<\/li>\n<li>Les supports souples ou rigides aident \u00e0 l&rsquo;alignement de la t\u00eate, du tronc et du bassin et peuvent inclure : une sangle abdominale, un support lat\u00e9ral du tronc, un support de t\u00eate.<sup id=\"cite_ref-:5_6-3\" class=\"reference\"><a href=\"#cite_note-:5-6\">(6)<\/a><\/sup><\/li>\n<\/ul>\n<h3><span id=\"Techniques\" class=\"mw-headline\">Techniques<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Techniques\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=19\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Techniques\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=19\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<h4><span id=\"Secretion_Mobilisation\" class=\"mw-headline\">Mobilisation des s\u00e9cr\u00e9tions <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Secretion Mobilisation\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=20\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Secretion Mobilisation\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=20\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Une personne atteinte d&rsquo;une l\u00e9sion de la moelle \u00e9pini\u00e8re peut avoir des difficult\u00e9s \u00e0 mobiliser ses s\u00e9cr\u00e9tions en raison d&rsquo;une faiblesse des muscles expiratoires (c&rsquo;est-\u00e0-dire une faiblesse du muscle oblique externe, du muscle oblique interne, du muscle droit et du muscle transversal de l&rsquo;abdomen). L&rsquo;hydratation ad\u00e9quate est un \u00e9l\u00e9ment important de la mobilisation efficace des s\u00e9cr\u00e9tions. Les patients doivent recevoir suffisamment de liquides pour r\u00e9pondre aux crit\u00e8res d&rsquo;une bonne hydratation. On l&rsquo;\u00e9value souvent par la couleur de l&rsquo;urine (vert-jaune p\u00e2le ou orange fonc\u00e9 en cas de d\u00e9shydratation).<\/p>\n<p>Les interventions primaires utilis\u00e9es pour la mobilisation des s\u00e9cr\u00e9tions incluent les \u00e9l\u00e9ments suivants :<\/p>\n<ul>\n<li><a title=\"Postural Drainage\" href=\"\/Postural_Drainage\">Drainage postural<\/a><\/li>\n<li>Aspiration<\/li>\n<li>Techniques de toux assist\u00e9e<\/li>\n<li>Percussions et vibrations<\/li>\n<li>Insufflation et exsufflation m\u00e9caniques<\/li>\n<\/ul>\n<h5><span id=\"Postural_Drainage\" class=\"mw-headline\">Drainage postural <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Postural Drainage\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=21\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Postural Drainage\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=21\">source d&rsquo;\u00e9dition<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h5>\n<p>Le drainage postural est la r\u00e9f\u00e9rence en mati\u00e8re de d\u00e9gagement des voies respiratoires. Il peut \u00eatre utilis\u00e9 pendant les routines quotidiennes de repos et de sommeil. Les positions choisies permettront \u00e0 la gravit\u00e9 d&rsquo;aider le mouvement des s\u00e9cr\u00e9tions vers les voies a\u00e9riennes sup\u00e9rieures pour qu&rsquo;elles soient \u00e9limin\u00e9es par la toux ou l&rsquo;aspiration. La dur\u00e9e du drainage postural peut varier de 5 \u00e0 10 minutes.<sup id=\"cite_ref-:0_1-8\" class=\"reference\"><a href=\"#cite_note-:0-1\">(1)<\/a><\/sup><\/p>\n<div class=\"thumb tnone\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Postural_drainage.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/6\/67\/Postural_drainage.jpg\/300px-Postural_drainage.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/6\/67\/Postural_drainage.jpg 1.5x\" alt=\"Postural drainage.jpg\" width=\"300\" height=\"526\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<h5><span id=\"Suctioning\" class=\"mw-headline\">Aspiration<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Suctioning\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=22\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Suctioning\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=22\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h5>\n<p>L&rsquo;<a title=\"Aspiration\" href=\"\/Suctioning\">aspiration<\/a> est une proc\u00e9dure invasive qui permet l&rsquo;\u00e9limination des s\u00e9cr\u00e9tions uniquement dans les grandes voies respiratoires. Bien que tr\u00e8s efficace, cette technique est traumatisante pour les tissus mous des voies respiratoires. <sup id=\"cite_ref-:5_6-4\" class=\"reference\"><a href=\"#cite_note-:5-6\">(6)<\/a><\/sup> L&rsquo;\u00e9tat clinique du patient doit \u00eatre pris en compte lorsque l&rsquo;on choisit d&rsquo;\u00e9liminer les s\u00e9cr\u00e9tions par aspiration. <sup id=\"cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\">(15)<\/a><\/sup><\/p>\n<p>Vous pouvez lire <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK557386\/\" rel=\"nofollow\">ici<\/a> les indications, la pr\u00e9paration et la technique n\u00e9cessaires pour effectuer une proc\u00e9dure d&rsquo;aspiration.<\/p>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 299px;\"><a class=\"image\" href=\"\/File:Melanie_Harding_Image_-_Assisting_Coughing_With_1_Person.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/6\/67\/Melanie_Harding_Image_-_Assisting_Coughing_With_1_Person.jpg\" alt=\"\" width=\"297\" height=\"396\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Aide \u00e0 la toux \u00e0 1 personne<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h5><span id=\"Assisted_Coughing_Techniques\" class=\"mw-headline\">Techniques de toux assist\u00e9e <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Assisted Coughing Techniques\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=23\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Assisted Coughing Techniques\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=23\">source d&rsquo;\u00e9dition<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h5>\n<ol>\n<li><a title=\"Assisted Coughing\" href=\"\/Assisted_Coughing\">Assistance manuelle \u00e0 la toux <\/a>: la personne qui assiste la personne atteinte d&rsquo;une l\u00e9sion de la moelle \u00e9pini\u00e8re appuie sur la partie inf\u00e9rieure de la cage thoracique des deux c\u00f4t\u00e9s ou sous le diaphragme pendant que le patient essaie de tousser. Il s&rsquo;agit d&rsquo;une force manuelle synchronis\u00e9e vers l&rsquo;int\u00e9rieur et vers le haut visant \u00e0 cr\u00e9er une pression intra-abdominale pour une toux vigoureuse efficace. Cette force manuelle va permettre aux muscles intercostaux et abdominaux d&rsquo;augmenter la pression intra-abdominale n\u00e9cessaire \u00e0 une toux efficace. <sup id=\"cite_ref-:0_1-9\" class=\"reference\"><a href=\"#cite_note-:0-1\">(1)<\/a><\/sup><sup id=\"cite_ref-:2_2-6\" class=\"reference\"><a href=\"#cite_note-:2-2\">(2)<\/a><\/sup><\/li>\n<li>Technique de la \u00ab\u00a0respiration de grenouille\u00a0\u00bb <a title=\"Glossopharyngeal Breathing\" href=\"\/Glossopharyngeal_Breathing\">(respiration glossopharyng\u00e9e<\/a>) : apr\u00e8s 6 \u00e0 9 cycles d&rsquo;expiration ou de toux, le patient effectue des mouvements d&rsquo;aspiration et de d\u00e9glutition pour faire descendre de petits volumes d&rsquo;air dans ses poumons.<\/li>\n<\/ol>\n<div class=\"row\">\n<div class=\"col-md-6\">\n<div class=\"thumb embedvideo autoResize\" style=\"width: 258px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 250px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/lp-LBgD5Y5M?\" width=\"250\" height=\"141\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<div class=\"text-right\"><sup id=\"cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\">(16)<\/a><\/sup><\/div>\n<\/div>\n<div class=\"col-md-6\">\n<div class=\"thumb embedvideo autoResize\" style=\"width: 258px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 250px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/9OswSaTG71I?\" width=\"250\" height=\"141\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<div class=\"text-right\"><sup id=\"cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\">(17)<\/a><\/sup><\/div>\n<\/div>\n<\/div>\n<h5><span id=\"Percussions_and_Vibrations\" class=\"mw-headline\">Percussions et vibrations <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Percussions and Vibrations\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=24\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Percussions and Vibrations\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=24\">modifier la source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h5>\n<p>Les <a title=\"Percussion\" href=\"\/Percussion\">percussions<\/a> et les vibrations sont des techniques manuelles utilis\u00e9es pour lib\u00e9rer les s\u00e9cr\u00e9tions en provoquant des vibrations dans la paroi thoracique. Des pr\u00e9cautions et contre-indications importantes doivent \u00eatre prises en compte avant l&rsquo;ex\u00e9cution de ces techniques.<\/p>\n<p>Les contre-indications sont les suivantes :<\/p>\n<ul>\n<li>Instabilit\u00e9 cardiovasculaire<\/li>\n<li><a title=\"Pneumothorax\" href=\"\/Pneumothorax\">Pneumothorax<\/a> sous tension<\/li>\n<li><a title=\"Tuberculosis\" href=\"\/Tuberculosis\">Tuberculose<\/a> pulmonaire active<\/li>\n<li><a title=\"Pulmonary Embolism\" href=\"\/Pulmonary_Embolism\">Embolie pulmonaire<\/a><\/li>\n<li>\u00c9panchement pleural grave<\/li>\n<li>Fractures instables de la colonne vert\u00e9brale et \/ ou du cr\u00e2ne<\/li>\n<li>C\u00f4tes fractur\u00e9es<\/li>\n<li>Blessures au thorax<\/li>\n<li>H\u00e9moptysie aigu\u00eb<\/li>\n<li>Augmentation de la pression intracr\u00e2nienne <sup id=\"cite_ref-:0_1-10\" class=\"reference\"><a href=\"#cite_note-:0-1\">(1)<\/a><\/sup><\/li>\n<\/ul>\n<div class=\"thumb embedvideo autoResize\" style=\"width: 648px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 640px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/qr-FJ3RdGuQ?\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\">(18)<\/a><\/sup><\/p>\n<h5><span id=\"Mechanical_Insufflation_and_Exsufflation\" class=\"mw-headline\">Insufflation et exsufflation m\u00e9caniques <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Mechanical Insufflation and Exsufflation\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=25\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Mechanical Insufflation and Exsufflation\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=25\">source d&rsquo;\u00e9dition<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h5>\n<p>Cette technique utilise un dispositif d&rsquo;assistance \u00e0 la toux via un masque facial ou un tube de trach\u00e9otomie pour pousser l&rsquo;air dans les poumons, puis les s\u00e9cr\u00e9tions sont aspir\u00e9es.<\/p>\n<div class=\"thumb embedvideo autoResize\" style=\"width: 648px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 640px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/mlc7Hk652UM?\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\">(19)<\/a><\/sup><\/p>\n<h4><span id=\"Specialised_Breathing_Techniques\" class=\"mw-headline\">Techniques respiratoires sp\u00e9cialis\u00e9es <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Specialised Breathing Techniques\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=26\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Specialised Breathing Techniques\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=26\">source d&rsquo;\u00e9dition<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<ul>\n<li>Superposition de respirations (ou superposition d&rsquo;air) : trois \u00e0 six respirations inspiratoires avant l&rsquo;expiration. Cette technique peut \u00eatre r\u00e9alis\u00e9e par la personne qui effectue <a title=\"Active Cycle of Breathing Technique\" href=\"\/Active_Cycle_of_Breathing_Technique\">activement<\/a> la <a title=\"Breath Stacking\" href=\"\/Breath_Stacking\">superposition des respirations<\/a> (techniques de reniflement respiratoire ou de retenue inspiratoire) ainsi qu&rsquo;avec un sac de r\u00e9animation muni d&rsquo;un embout buccal ou d&rsquo;un masque facial. <sup id=\"cite_ref-:2_2-7\" class=\"reference\"><a href=\"#cite_note-:2-2\">(2)<\/a><\/sup><sup id=\"cite_ref-:4_11-3\" class=\"reference\"><a href=\"#cite_note-:4-11\">(11)<\/a><\/sup><\/li>\n<li>Active Cycle of Breathing (ACBT) &#8211; Cycle actif de la respiration : permet d&rsquo;\u00e9vacuer les expectorations des poumons. Consiste en 3 phases : la respiration douce et d\u00e9tendue, la respiration profonde et l&rsquo;expiration (petite-longue et grande-courte). <sup id=\"cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\">(20)<\/a><\/sup><\/li>\n<li>Drainage autog\u00e8ne : respiration \u00e0 volume pulmonaire faible, moyen et \u00e9lev\u00e9 pour mobiliser, collecter et \u00e9vacuer le mucus, suivie de techniques d&rsquo;expiration forc\u00e9e. <sup id=\"cite_ref-:5_6-5\" class=\"reference\"><a href=\"#cite_note-:5-6\">(6)<\/a><\/sup><\/li>\n<\/ul>\n<div class=\"thumb embedvideo autoResize\" style=\"width: 648px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 640px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/a3n0l7vQTag?\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\">(21)<\/a><\/sup><\/p>\n<h4><span id=\"Stretching_Techniques\" class=\"mw-headline\">Techniques d&rsquo;\u00e9tirement <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Stretching Techniques\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=27\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Stretching Techniques\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=27\">source d&rsquo;\u00e9dition<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>En position couch\u00e9e sur le dos ou sur le c\u00f4t\u00e9 :<\/p>\n<ul>\n<li>\u00c9tirement passif de la cage thoracique en position lat\u00e9rale ou couch\u00e9e sur le dos. Le patient a un oreiller plac\u00e9 sous la cage thoracique ou un rouleau de serviette le long de la colonne vert\u00e9brale.<\/li>\n<li>\u00c9tirement actif utilisant des mouvements passifs des membres sup\u00e9rieurs en abduction avec rotation externe jumel\u00e9e \u00e0 l&rsquo;inspiration et en adduction avec rotation interne jumel\u00e9e \u00e0 l&rsquo;expiration.<\/li>\n<\/ul>\n<p>En position assise ou couch\u00e9e :<\/p>\n<ul>\n<li>Pincement des \u00e9paules lors de l&rsquo;inhalation<\/li>\n<li>Les yeux et la t\u00eate s&rsquo;\u00e9l\u00e8vent avec une extension passive ou active du tronc associ\u00e9e \u00e0 une inspiration.<\/li>\n<li>Les yeux et la t\u00eate descendent avec la flexion passive ou active du tronc associ\u00e9e \u00e0 l&rsquo;expiration.<\/li>\n<li>Rotation passive ou active du tronc avec mouvement de la t\u00eate. Le physioth\u00e9rapeute demande au patient de regarder par-dessus son \u00e9paule et d&rsquo;inspirer pendant que le clinicien d\u00e9place passivement ou activement le(s) bras du patient vers le haut et l&rsquo;arri\u00e8re. Au retour, le(s) bras est(sont) ramen\u00e9(s) vers le genou oppos\u00e9 pendant que le patient expire. L&rsquo;objectif est d&rsquo;activer les muscles intercostaux et obliques.<sup id=\"cite_ref-:5_6-6\" class=\"reference\"><a href=\"#cite_note-:5-6\">(6)<\/a><\/sup><\/li>\n<\/ul>\n<h4><span id=\"Soft_tissue_release\" class=\"mw-headline\">Rel\u00e2chement des tissus mous <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Soft tissue release\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=28\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Soft tissue release\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=28\">source d&rsquo;\u00e9dition<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p><a class=\"mw-redirect\" title=\"Myofascial Release\" href=\"\/Myofascial_Release\">Rel\u00e2chement myofasciale<\/a> pour les intercostaux, le <a title=\"Quadratus Lumborum\" href=\"\/Quadratus_Lumborum\">carr\u00e9 des lombes<\/a>, les <a title=\"Abdominal Muscles\" href=\"\/Abdominal_Muscles\">abdominaux<\/a>, les <a title=\"Pectoralis major\" href=\"\/Pectoralis_major\">pectoraux<\/a>.<\/p>\n<div class=\"row\">\n<div class=\"col-md-6\">\n<div class=\"thumb embedvideo autoResize\" style=\"width: 258px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 250px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/I9LvnpTqWAI?\" width=\"250\" height=\"141\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<div class=\"text-right\"><sup id=\"cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\">(22)<\/a><\/sup><\/div>\n<\/div>\n<div class=\"col-md-6\">\n<div class=\"thumb embedvideo autoResize\" style=\"width: 258px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 250px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/0EfmqYgl7zM?\" width=\"250\" height=\"141\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<div class=\"text-right\"><sup id=\"cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\">(23)<\/a><\/sup><\/div>\n<\/div>\n<\/div>\n<h4><span id=\"Respiratory_Muscle_Training\" class=\"mw-headline\">Entra\u00eenement des muscles respiratoires <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Respiratory Muscle Training\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=29\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Respiratory Muscle Training\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=29\">source d&rsquo;\u00e9dition<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p><a title=\"Respiratory Muscle Training\" href=\"\/Respiratory_Muscle_Training\">L&rsquo;entra\u00eenement des muscles respiratoires<\/a> implique l&rsquo;utilisation de valves unidirectionnelles pour cibler les muscles inspiratoires ou expiratoires. <sup id=\"cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\">(24)<\/a><\/sup><sup id=\"cite_ref-:7_25-0\" class=\"reference\"><a href=\"#cite_note-:7-25\">(25)<\/a><\/sup>. Les entra\u00eeneurs respiratoires sont divis\u00e9s en :<\/p>\n<ul>\n<li>Entra\u00eeneurs inspiratoires (P-flex, Threshold IMT, The Breather), et<\/li>\n<li>Entra\u00eeneurs expiratoires (Resistex, Threshold <a title=\"Positive Expiratory Pressure (PEP) Devices\" href=\"\/Positive_Expiratory_Pressure_(PEP)_Devices\">PEP<\/a>, The Breather)<\/li>\n<\/ul>\n<h4><span id=\"Non-Invasive_Ventilatory_(NIV)_Support\"><\/span><span id=\"Non-Invasive_Ventilatory_.28NIV.29_Support\" class=\"mw-headline\">Ventilation non invasive (VNI) <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Non-Invasive Ventilatory (NIV) Support\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=30\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Non-Invasive Ventilatory (NIV) Support\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=30\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Cette technique applique une pression positive dans les voies respiratoires et est connue sous le nom d&rsquo;assistance en pression positive. Exemples d&rsquo;appareils de ventilation en pression positive : CPAP, BPAP et <a title=\"Intermittent positive pressure breathing\" href=\"\/Intermittent_positive_pressure_breathing\">IPPB<\/a>. Les individus doivent \u00eatre coop\u00e9ratifs et la technique pr\u00e9f\u00e9r\u00e9e doit \u00eatre conduite le jour via un embout buccal et la nuit, via un embout nasal. L&rsquo;assistance VNI est \u00e9galement connue pour son utilisation comme soutien ventilatoire initial ou de sevrage et comme soutien nocturne.<\/p>\n<div class=\"thumb embedvideo autoResize\" style=\"width: 648px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 640px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/CSxIpYitK1o\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\">(26)<\/a><\/sup><\/p>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 335px;\"><a class=\"image\" href=\"\/File:Abdominal_binder.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/6\/68\/Abdominal_binder.jpg\/333px-Abdominal_binder.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/6\/68\/Abdominal_binder.jpg\/500px-Abdominal_binder.jpg 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/6\/68\/Abdominal_binder.jpg\/666px-Abdominal_binder.jpg 2x\" alt=\"\" width=\"333\" height=\"331\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Bande de soutien abdominale<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h3><span id=\"Early_Mobilisation\" class=\"mw-headline\">Mobilisation pr\u00e9coce <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Early Mobilisation\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=31\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Early Mobilisation\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=31\">source d&rsquo;\u00e9dition<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Il s&rsquo;agit d&rsquo;une technique efficace pour \u00e9liminer les s\u00e9cr\u00e9tions et am\u00e9liorer la ventilation.<sup id=\"cite_ref-:7_25-1\" class=\"reference\"><a href=\"#cite_note-:7-25\">(25)<\/a><\/sup> Les physioth\u00e9rapeutes peuvent aider les personnes atteintes d&rsquo;une l\u00e9sion de la moelle \u00e9pini\u00e8re \u00e0 s&rsquo;asseoir sur une chaise une fois que les fractures de la colonne vert\u00e9brale sont stabilis\u00e9es chirurgicalement. Il est prouv\u00e9 que la mobilisation pr\u00e9coce acc\u00e9l\u00e8re le r\u00e9tablissement et r\u00e9duit la dur\u00e9e d&rsquo;hospitalisation. Il est cependant extr\u00eamement important que les physioth\u00e9rapeutes envisagent l&rsquo;utilisation de bandes de soutien abdominale et une \u00e9l\u00e9vation lente et progressive pendant la phase de choc spinal, car une personne atteinte de l\u00e9sions de la moelle \u00e9pini\u00e8re peut \u00eatre confront\u00e9e \u00e0 de l&rsquo;hypotension et \u00e0 un travail respiratoire plus difficile en position verticale. Des m\u00e9dicaments antihypertenseurs peuvent \u00e9galement \u00eatre administr\u00e9s par l&rsquo;\u00e9quipe m\u00e9dicale si cela est indiqu\u00e9.<sup id=\"cite_ref-:2_2-8\" class=\"reference\"><a href=\"#cite_note-:2-2\">(2)<\/a><\/sup><\/p>\n<h3><span id=\"Long-Term_Ventilation\" class=\"mw-headline\">Ventilation \u00e0 long terme <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Long-Term Ventilation\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=32\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Long-Term Ventilation\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=32\">source d&rsquo;\u00e9dition<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Les personnes souffrant d&rsquo;une l\u00e9sion de la moelle \u00e9pini\u00e8re de C4 ou plus haut ont souvent besoin d&rsquo;une assistance respiratoire \u00e0 long terme. L&rsquo;\u00e9ducation des aidants et un entra\u00eenement approfondi doivent \u00eatre men\u00e9s par l&rsquo;ensemble de l&rsquo;\u00e9quipe multidisciplinaire. Des \u00e9valuations m\u00e9dicales et physioth\u00e9rapeutiques fr\u00e9quentes sont conseill\u00e9es afin de surveiller l&rsquo;\u00e9tat de la personne.<sup id=\"cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\">(27)<\/a><\/sup><\/p>\n<h2><span id=\"References\" class=\"mw-headline\">R\u00e9f\u00e9rences<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: References\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;veaction=edit&amp;section=33\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: References\" href=\"\/index.php?title=Respiratory_Management_in_Spinal_Cord_Injury&amp;action=edit&amp;section=33\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<div class=\"mw-references-wrap mw-references-columns\">\n<ol class=\"references\">\n<li id=\"cite_note-:0-1\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:0_1-0\">1.00<\/a><\/sup> <sup><a href=\"#cite_ref-:0_1-1\">1.01<\/a><\/sup> <sup><a href=\"#cite_ref-:0_1-2\">1.02<\/a><\/sup> <sup><a href=\"#cite_ref-:0_1-3\">1.03<\/a><\/sup> <sup><a href=\"#cite_ref-:0_1-4\">1.04<\/a><\/sup> <sup><a href=\"#cite_ref-:0_1-5\">1.05<\/a><\/sup> <sup><a href=\"#cite_ref-:0_1-6\">1.06<\/a><\/sup> <sup><a href=\"#cite_ref-:0_1-7\">1.07<\/a><\/sup> <sup><a href=\"#cite_ref-:0_1-8\">1.08<\/a><\/sup> <sup><a href=\"#cite_ref-:0_1-9\">1.09<\/a><\/sup> <sup><a href=\"#cite_ref-:0_1-10\">1.10<\/a><\/sup><\/span> <span class=\"reference-text\">Galeiras V\u00e1zquez R, Rascado Sedes P, Mourelo Fari\u00f1a M, Montoto Marqu\u00e9s A, Ferreiro Velasco ME. Respiratory management in the patient with spinal cord injury. BioMed research international. 2013;2013.<\/span><\/li>\n<li id=\"cite_note-:2-2\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:2_2-0\">2.0<\/a><\/sup> <sup><a href=\"#cite_ref-:2_2-1\">2.1<\/a><\/sup> <sup><a href=\"#cite_ref-:2_2-2\">2.2<\/a><\/sup> <sup><a href=\"#cite_ref-:2_2-3\">2.3<\/a><\/sup> <sup><a href=\"#cite_ref-:2_2-4\">2.4<\/a><\/sup> <sup><a href=\"#cite_ref-:2_2-5\">2.5<\/a><\/sup> <sup><a href=\"#cite_ref-:2_2-6\">2.6<\/a><\/sup> <sup><a href=\"#cite_ref-:2_2-7\">2.7<\/a><\/sup> <sup><a href=\"#cite_ref-:2_2-8\">2.8<\/a><\/sup><\/span> <span class=\"reference-text\">Berlowitz DJ, Wadsworth B, Ross J. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5335574\/\" rel=\"nofollow\">Respiratory problems and management in people with spinal cord injury<\/a>. Breathe. 2016 Dec 1;12(4):328-40.<\/span><\/li>\n<li id=\"cite_note-:1-3\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:1_3-0\">3.0<\/a><\/sup> <sup><a href=\"#cite_ref-:1_3-1\">3.1<\/a><\/sup><\/span> <span class=\"reference-text\">Zakrasek EC, Nielson JL, Kosarchuk JJ, Crew JD, Ferguson AR, McKenna SL. Pulmonary outcomes following specialized respiratory management for acute cervical spinal cord injury: a retrospective analysis. Spinal cord. 2017 Jun;55(6):559-65.<\/span><\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-4\">\u2191<\/a><\/span> <span class=\"reference-text\">Hagen EM. Acute complications of spinal cord injuries. World journal of orthopedics. 2015 Jan 18;6(1):17.<\/span><\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-5\">\u2191<\/a><\/span> <span class=\"reference-text\">Sampol J, Gonz\u00e1lez-Viejo M\u00c1, G\u00f3mez A, Mart\u00ed S, Pallero M, Rodr\u00edguez E, Launois P, Sampol G, Ferrer J. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7312109\/\" rel=\"nofollow\">Predictors of respiratory complications in patients with C5\u2013T5 spinal cord injuries.<\/a> Spinal Cord. 2020 Dec;58(12):1249-54.<\/span><\/li>\n<li id=\"cite_note-:5-6\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:5_6-0\">6.0<\/a><\/sup> <sup><a href=\"#cite_ref-:5_6-1\">6.1<\/a><\/sup> <sup><a href=\"#cite_ref-:5_6-2\">6.2<\/a><\/sup> <sup><a href=\"#cite_ref-:5_6-3\">6.3<\/a><\/sup> <sup><a href=\"#cite_ref-:5_6-4\">6.4<\/a><\/sup> <sup><a href=\"#cite_ref-:5_6-5\">6.5<\/a><\/sup> <sup><a href=\"#cite_ref-:5_6-6\">6.6<\/a><\/sup><\/span> <span class=\"reference-text\">Massery, M. \u00ab\u00a0If You Can&rsquo;t Breathe, You Can&rsquo;t Function\u00a0\u00bb continuing education class 20 hrs. Feb 21-23, 2008. Rehabilitation Institute of Chicago, Chicago, IL. <\/span><\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-7\">\u2191<\/a><\/span> <span class=\"reference-text\">2D &amp; 3D Animation and Explainer Videos. 3D Medical Mechanics of breathing L v 1 0. Available from: <a class=\"external free\" href=\"https:\/\/www.youtube.com\/watch?v=MPovpAXcmIU\" rel=\"nofollow\">https:\/\/www.youtube.com\/watch?v=MPovpAXcmIU<\/a> (last accessed 5\/2\/2022)<\/span><\/li>\n<li id=\"cite_note-:3-8\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:3_8-0\">8.0<\/a><\/sup> <sup><a href=\"#cite_ref-:3_8-1\">8.1<\/a><\/sup><\/span> <span class=\"reference-text\">Benditt JO. <a class=\"external text\" href=\"http:\/\/rc.rcjournal.com\/content\/respcare\/51\/8\/829.full.pdf\" rel=\"nofollow\">The Neuromuscular Respiratory System: Physiology, Pathophysiology, and a Respiratory Care Approach to Patients<\/a>. Respiratory Care Aug 2006, 51 (8) 829-839;<\/span><\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-9\">\u2191<\/a><\/span> <span class=\"reference-text\">Dr. Matt&amp;Dr. Mike. Neural Control of Breathing | Respiratory System. 2019. Available from: <a class=\"external free\" href=\"https:\/\/www.youtube.com\/watch?v=GqkMzds77f8\" rel=\"nofollow\">https:\/\/www.youtube.com\/watch?v=GqkMzds77f8<\/a>(last accessed 7\/2\/2022)<\/span><\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-10\">\u2191<\/a><\/span> <span class=\"reference-text\">Kaneko H, Shiranita S, Horie J, Hayashi S. <a class=\"external text\" href=\"http:\/\/rc.rcjournal.com\/content\/61\/11\/1472\" rel=\"nofollow\">Reduced Chest and Abdominal Wall Mobility and Their Relationship to Lung Function, Respiratory Muscle Strength, and Exercise Tolerance in Subjects With COPD<\/a>. Respir Care. 2016 Nov;61(11):1472-1480. <\/span><\/li>\n<li id=\"cite_note-:4-11\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:4_11-0\">11.0<\/a><\/sup> <sup><a href=\"#cite_ref-:4_11-1\">11.1<\/a><\/sup> <sup><a href=\"#cite_ref-:4_11-2\">11.2<\/a><\/sup> <sup><a href=\"#cite_ref-:4_11-3\">11.3<\/a><\/sup><\/span> <span class=\"reference-text\">Tollefsen E, Fondenes O. <a class=\"external text\" href=\"https:\/\/tidsskriftet.no\/en\/2012\/05\/respiratory-complications-associated-spinal-cord-injury\" rel=\"nofollow\">Respiratory complications associated with spinal cord injury<\/a>. Tidsskr Nor Laegeforen. 2012 May 15;132(9):1111-4. <\/span><\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-12\">\u2191<\/a><\/span> <span class=\"reference-text\">Raab AM, Mueller G, Elsig S, Gandevia SC, Zwahlen M, Hopman MT, Hilfiker R. <a class=\"external text\" href=\"https:\/\/www.mdpi.com\/2077-0383\/11\/1\/211\/htm\" rel=\"nofollow\">Systematic Review of Incidence Studies of Pneumonia in Persons with Spinal Cord Injury<\/a>. Journal of clinical medicine. 2022 Jan;11(1):211.<\/span><\/li>\n<li id=\"cite_note-:6-13\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:6_13-0\">13.0<\/a><\/sup> <sup><a href=\"#cite_ref-:6_13-1\">13.1<\/a><\/sup> <sup><a href=\"#cite_ref-:6_13-2\">13.2<\/a><\/sup><\/span> <span class=\"reference-text\">Crytzer TM, Hong EK, Dicianno BE, Pearlman J, Schmeler M, Cooper RA. Identifying characteristic back shapes from anatomical scans of wheelchair users to improve seating design. Med Eng Phys. 2016 Sep;38(9):999-1007. <\/span><\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-14\">\u2191<\/a><\/span> <span class=\"reference-text\">Halkiotis E, Mogul-Rotman B. <a class=\"external text\" href=\"http:\/\/seatingsymposium.comhttps:\/\/www.physio-pedia.com\/images\/pdf\/ISS2020_Syllabus.pdf#page=75\" rel=\"nofollow\">B2: BACK IT UP! Back Supports\u2019 Impact on Body Systems and Scapular Function<\/a>. SYLLABUS. 2020 Mar 4:73.<\/span><\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-15\">\u2191<\/a><\/span> <span class=\"reference-text\">Pasrija D, Hall CA. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK557386\/\" rel=\"nofollow\">Airway Suctioning<\/a>. (Updated 2021 Sep 21). In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK557386\/<\/span><\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-16\">\u2191<\/a><\/span> <span class=\"reference-text\">SpinalHub. How to assist cough a person with spinal cord injury. Available from: <a class=\"external free\" href=\"https:\/\/www.youtube.com\/watch?v=lp-LBgD5Y5M\" rel=\"nofollow\">https:\/\/www.youtube.com\/watch?v=lp-LBgD5Y5M<\/a> (last accessed 3\/10\/2020)<\/span><\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-17\">\u2191<\/a><\/span> <span class=\"reference-text\">CANVent Ottawa. Glossopharyngeal Breathing. 2015. <a class=\"external free\" href=\"https:\/\/www.youtube.com\/watch?v=9OswSaTG71I\" rel=\"nofollow\">https:\/\/www.youtube.com\/watch?v=9OswSaTG71I<\/a> (last accessed 15\/2\/2022)<\/span><\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-18\">\u2191<\/a><\/span> <span class=\"reference-text\">Jack Thompson. Percussion, vibration and shaking for clearing secretions. Available from: <a class=\"external free\" href=\"https:\/\/www.youtube.com\/watch?v=qr-FJ3RdGuQ\" rel=\"nofollow\">https:\/\/www.youtube.com\/watch?v=qr-FJ3RdGuQ<\/a> (last accessed 3\/10\/2020)<\/span><\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-19\">\u2191<\/a><\/span> <span class=\"reference-text\">CANVentOttawa. Mechanical Insufflation-Exsufflation with a Tracheostomy. 2017. Available from: <a class=\"external free\" href=\"https:\/\/www.youtube.com\/watch?v=mlc7Hk652UM\" rel=\"nofollow\">https:\/\/www.youtube.com\/watch?v=mlc7Hk652UM<\/a> (last accessed 15\/02\/2022)<\/span><\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-20\">\u2191<\/a><\/span> <span class=\"reference-text\">Association of Chartered Physiotherapists in Respiratory Care.The Active Cycle of Breathing Techniques. Available at <a class=\"external free\" href=\"https:\/\/www.acprc.org.uk\/Data\/Publication_Downloads\/GL-05ACBT.pdf\" rel=\"nofollow\">https:\/\/www.acprc.org.uk\/Data\/Publication_Downloads\/GL-05ACBT.pdf<\/a> (last accessed 14.02.2022)<\/span><\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-21\">\u2191<\/a><\/span> <span class=\"reference-text\">Cork University Hospital. Breath Stacking Techniques. 2019. Available from: <a class=\"external free\" href=\"https:\/\/www.youtube.com\/watch?v=a3n0l7vQTag\" rel=\"nofollow\">https:\/\/www.youtube.com\/watch?v=a3n0l7vQTag<\/a> (last accessed 15\/02\/2022)<\/span><\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-22\">\u2191<\/a><\/span> <span class=\"reference-text\">AdvancedTrainings. Intercostal Technique (Rib Bucket Handles) &#8211; Advanced Myofascial Techniques DVD Series. 2011. Available from: <a class=\"external free\" href=\"https:\/\/www.youtube.com\/watch?v=I9LvnpTqWAI\" rel=\"nofollow\">https:\/\/www.youtube.com\/watch?v=I9LvnpTqWAI<\/a>(last accessed 16\/02\/2022)<\/span><\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-23\">\u2191<\/a><\/span> <span class=\"reference-text\">John Gibbons. Myofascial release treatment for the Pectorals and Subscapularis using Soft Tissue Release (STR). 2014. <a class=\"external free\" href=\"https:\/\/www.youtube.com\/watch?v=0EfmqYgl7zM\" rel=\"nofollow\">https:\/\/www.youtube.com\/watch?v=0EfmqYgl7zM<\/a> (last accessed 15\/2\/2022)<\/span><\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-24\">\u2191<\/a><\/span> <span class=\"reference-text\">Tamplin J, Berlowitz DJ. A systematic review and meta-analysis of the effects of respiratory muscle training on pulmonary function in tetraplegia. Spinal Cord. 2014 Mar;52(3):175-80.<\/span><\/li>\n<li id=\"cite_note-:7-25\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:7_25-0\">25.0<\/a><\/sup> <sup><a href=\"#cite_ref-:7_25-1\">25.1<\/a><\/sup><\/span> <span class=\"reference-text\">Wang HC, Lin YT, Huang CC, Lin MC, Liaw MY, Lu CH. <a class=\"external text\" href=\"https:\/\/www.mdpi.com\/2075-4426\/11\/5\/377\/htm\" rel=\"nofollow\">Effects of respiratory muscle training on baroreflex sensitivity, respiratory function, and serum oxidative stress in acute cervical spinal cord injury<\/a>. Journal of Personalized Medicine. 2021 May;11(5):377.<\/span><\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-26\">\u2191<\/a><\/span> <span class=\"reference-text\">NIck Smith.CPAP and Non-Invasive Ventilation in 5 minutes. 2015. Available from: <a class=\"external free\" href=\"https:\/\/www.youtube.com\/watch?v=OHQK5PUTQ_0\" rel=\"nofollow\">https:\/\/www.youtube.com\/watch?v=OHQK5PUTQ_0<\/a> (last accessed 16\/02\/2022)<\/span><\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-27\">\u2191<\/a><\/span> <span class=\"reference-text\">Schreiber AF, Garlasco J, Vieira F, Lau YH, Stavi D, Lightfoot D, Rigamonti A, Burns K, Friedrich JO, Singh JM, Brochard LJ. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8542415\/\" rel=\"nofollow\">Separation from mechanical ventilation and survival after spinal cord injury: a systematic review and meta-analysis<\/a>. Ann Intensive Care. 2021 Oct 24;11(1):149.<\/span><\/li>\n<\/ol>\n<\/div>\n<p><!-- NewPP limit report Cached time: 20220725180253 Cache expiry: 0 Dynamic content: true Complications: () CPU time usage: 0.194 seconds Real time usage: 0.227 seconds Preprocessor visited node count: 693\/1000000 Post\u2010expand include size: 339\/2097152 bytes Template argument size: 0\/2097152 bytes Highest expansion depth: 3\/40 Expensive parser function count: 0\/100 Unstrip recursion depth: 0\/20 Unstrip post\u2010expand size: 22044\/5000000 bytes --><br \/>\n<!-- Transclusion expansion time report (%,ms,calls,template) 100.00% 31.966 1 Special:Contributors\/Respiratory_Management_in_Spinal_Cord_Injury 100.00% 31.966 1 -total --><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>\u00c9diteur original &#8211; Eugenie Lamprecht Principaux contributeurs &#8211; Ewa Jaraczewska, Eugenie Lamprecht, Lucinda hampton, Jess Bell, Kim Jackson, Naomi O&rsquo;Reilly, Vidya Acharya, Chelsea Mclene et Kirenga Bamurange Liliane Contenu 1 Introduction 2 Respiration normale 2.1 Musculo-squelettique 2.2 Neuromusculaire 2.3 T\u00e9gumentaire (peau) 3 L\u00e9sion de la moelle \u00e9pini\u00e8re et respiration 3.1 Complications respiratoires 3.1.1 Toux et [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-2407","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/langs.physio-pedia.com\/fr\/wp-json\/wp\/v2\/pages\/2407","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/langs.physio-pedia.com\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/langs.physio-pedia.com\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/langs.physio-pedia.com\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/langs.physio-pedia.com\/fr\/wp-json\/wp\/v2\/comments?post=2407"}],"version-history":[{"count":3,"href":"https:\/\/langs.physio-pedia.com\/fr\/wp-json\/wp\/v2\/pages\/2407\/revisions"}],"predecessor-version":[{"id":5686,"href":"https:\/\/langs.physio-pedia.com\/fr\/wp-json\/wp\/v2\/pages\/2407\/revisions\/5686"}],"wp:attachment":[{"href":"https:\/\/langs.physio-pedia.com\/fr\/wp-json\/wp\/v2\/media?parent=2407"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}