A C4 cervical injury may require which respiratory support?

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High cervical injuries disrupt the nerves that control the main breathing muscle, the diaphragm. The diaphragm is primarily innervated by the phrenic nerve from spinal cord segments C3–C5, so an injury at C4 can weaken or paralyze diaphragmatic function. When diaphragmatic effort is compromised, breathing and effective coughing become difficult, and the risk of respiratory failure is high in the acute phase. Because of this, ventilatory support is often needed to maintain oxygenation and carbon dioxide elimination while the patient stabilizes and any potential for recovery of respiratory function is assessed. That’s why mechanical ventilation overnight is the most appropriate support in this scenario. Relying on no support or only minimal observation isn’t safe with a high cervical injury, and while some patients may improve later, immediate ventilation is commonly required after a C4 injury.