Can a cervical spine injury at the C5 level with spinal shock cause increased oral secretions?

Cervical Spine Injury at C5 Level with Spinal Shock Can Cause Increased Oral Secretions

Yes, cervical spine injury at the C5 level with spinal shock can cause increased oral secretions due to compromised ability to clear secretions effectively. 1

Pathophysiological Mechanisms

• C5 cervical spine injury causes significant expiratory muscle weakness while preserving some diaphragmatic function, leading to ineffective clearance of secretions 1
• Patients with C5 injuries have compromised ability to generate adequate expiratory pressures needed for effective cough, resulting in secretion retention 1
• Reduced lung volumes and inability to take deep breaths impair the normal mucociliary escalator function that would typically help clear secretions 1
• Decreased expiratory flow rates fail to stimulate the mucociliary apparatus that would normally assist in secretion clearance 1

Clinical Manifestations

• High incidence of aspiration (33%) and penetration (41%) has been documented in patients with traumatic cervical spinal cord injuries 2
• Of patients who aspirate, 73% experience silent aspiration, making this a dangerous complication that can go undetected 2
• Accumulated secretions may present as drooling, gurgling sounds during breathing, or frequent need for suctioning 1

Management Approaches

• A bundle approach is recommended to manage respiratory complications in cervical cord injury, including: 3, 1

  • Active physiotherapy and mechanically-assisted insufflation/exsufflation devices to remove bronchial secretions
  • Aerosol therapy combining beta-2 mimetics and anticholinergics to manage bronchial secretions
  • Abdominal contention belt during periods of spontaneous breathing

• Early tracheostomy (within 7 days) is suggested for patients with upper cervical spine injuries (C2-C5) to accelerate ventilatory weaning and manage secretions 3, 1

• Protocols combining early extubation followed by intensive respiratory physiotherapy with bronchial drainage and mechanically assisted coughing can sometimes lead to successful respiratory management without tracheostomy 3

Prevention Strategies and Monitoring

• Swallowing function should be routinely evaluated before initiating oral feeding in patients with acute cervical spine injury 2
• Videofluoroscopic swallowing study (VFSS) is highly recommended to rule out silent aspiration and determine safe nutrition consistency 2
• Early implementation of respiratory protocols including bronchial drainage physiotherapy and assisted cough with insufflator/exsufflator devices can improve outcomes 1

Pitfalls and Caveats

• Silent aspiration occurs in 73% of patients who aspirate, making it a dangerous complication that requires vigilant monitoring 2
• Positioning affects respiratory function - tetraplegic patients often tolerate lying down better than sitting due to effects of gravity on abdominal contents and inspiratory capacity 3
• Failure to recognize and manage increased secretions can lead to respiratory complications, which are a leading cause of morbidity and mortality in cervical spine injury 1