Abstract

Background/Objectives: Spinal cord injury (SCI) frequently leads to impaired respiratory function and increased pneumonia risk due to reduced respiratory muscle strength, altered thoracic compliance, autonomic dysregulation, and diaphragm displacement. This guideline aims to ensure appropriate, high-quality, and quality-assured care for individuals requiring respiratory support. Methods: This work represents a consensus-based S2k guideline developed by the “BeAtmung” working group of the German-speaking Medical Society for Paraplegiology (DMGP), in collaboration with experts from Germany and Switzerland, and endorsed by eight professional societies. Development followed the German Association of the Scientific Medical Societies (AWMF) guidance manual. Topics were defined in editorial meetings, supported by targeted literature searches and existing guidelines. Drafts were revised regularly with written feedback and final approval was granted after a consensus conference on 18 January 2022. Results: The guideline includes 11 specific recommendations addressing ventilation, monitoring, care structures, and discharge planning. Recommendations were graded using a three-level scheme (“need,” “should,” and “can be considered”) and consensus strength was classified as strong (>95%), consensus (>75–95%), majority (>50–75%), or no consensus (<50%). These recommendations support clinical decision-making and promote standardised, high-quality respiratory care for people with SCI. Conclusion: This guideline provides consensus-based recommendations for the comprehensive respiratory management of individuals with acute and chronic SCI, integrating diagnostic, therapeutic, and long-term care strategies to support high-quality, coordinated care across settings and healthcare systems.

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