The Effects of Prone Positioning in Spontaneously Breathing Tetraplegic Patients with Respiratory Impairment: A retrospective Cohort Study Protocol

Background: Patients with high cervical spinal cord injuries frequently experience respiratory impairment due to paralysis of the intercostal and abdominal muscles. Although prone positioning has been shown to improve oxygenation and secretion clearance in various patient populations, its effects in spontaneously breathing tetraplegic patients remain insufficiently studied. This study aims to evaluate the physiological effects, feasibility, and safety of prone positioning in this complex and vulnerable population. Methods: This retrospective cohort study will analyze routinely collected clinical data from spontaneously breathing tetraplegic patients who underwent prone positioning at Heidelberg University Hospital. Parameters including oxygen saturation (SpO₂), arterial blood gases, respiratory rate, and secretion mobilization will be assessed before, during, and after prone positioning. Data from July 10, 2017 to February 28, 2025 will be included. Statistical analyses will incorporate both descriptive and inferential methods appropriate for paired data. Discussion: The study is expected to provide foundational evidence on the effects of prone positioning in non-intubated tetraplegic patients with respiratory impairment. Findings may inform clinical decision-making and contribute to the development of evidence-based positioning protocols in spinal cord injury care.