Open Airway Surgery in a Paraplegic: The Importance of an Adequate Cough

Objectives: To describe a case of open airway surgery with postoperative respiratory complications in a paraplegic woman and to review the unique respiratory physiology seen in patients with a history of cervical or thoracic spinal cord injury (SCI). Methods Case report and literature review. Results: We describe the case of a 25-year-old paraplegic who developed tracheal stenosis after tracheotomy, eventually requiring tracheal resection and re-anastomosis. Her postoperative course was complicated by mucus plugging and severe atelectasis, necessitating reintubation. After extubation, the patient reported difficulty expectorating secretions ever since her SCI, requiring manual abdominal pressure from her family members to assist her when she needed to cough. Conclusion: This first report of cricotracheal resection in a patient with paraplegia following SCI highlights the importance of an adequate cough and demonstrates the unique respiratory management necessary for patients with SCI.