Few case reports have documented patients with respiratory muscle paralysis due to spinal cord infarction or the need for ventilation. Objective：Herein, we report a case of non-invasive positive pressure ventilation (NPPV) -aided respiratory management. Patients：A 46-year-old man experienced sudden breathing difficulty, and, owing to respiratory failure, underwent tracheostomy and mechanical ventilation following tracheal intubation. The patient exhibited complete limb paralysis and was diagnosed with spinal cord infarction. Methods：Ventilator weaning was challenging, and necessitated patient transfer to our hospital. Results：Upon admission, the patient exhibited a forced vital capacity of 250 mL and required complete assistance. The ventilator settings were adjusted to a tidal volume of 20 mL/kg of the ideal body weight and positive end expiratory pressure off. One month post-admission, the patient was transferred for all day respiratory management with NPPV. One year after the onset, the patient's vital capacity improved to 1960 mL. The patient engaged in activities involving changes in body position or transfer training, gait training, and activities of daily living training with NPPV. Following training, the patient could independently propel a wheelchair and walk 40 m using a walker. The patient could also eat, brush his teeth using a self-help device, and independently wipe their face.Conclusion：Respiratory dysfunction in this case was a ventilatory impairment resulting from respiratory muscle paralysis. Pulmonary rehabilitation for cervical spinal cord injury facilitates respiratory management with NPPV, improves respiratory condition, and reduces the amount of assistance.

Few case reports have documented patients with respiratory muscle paralysis due to spinal cord infarction or the need for ventilation. Objective：Herein, we report a case of non-invasive positive pressure ventilation (NPPV)-aided respiratory management. Patients：A 46-year-old man experienced sudden breathing difficulty, and, owing to respiratory failure, underwent tracheostomy and mechanical ventilation following tracheal intubation. The patient exhibited complete limb paralysis and was diagnosed with spinal cord infarction. Methods：Ventilator weaning was challenging, and necessitated patient transfer to our hospital. Results：Upon admission, the patient exhibited a forced vital capacity of 250 mL and required complete assistance. The ventilator settings were adjusted to a tidal volume of 20 mL/kg of the ideal body weight and positive end expiratory pressure off. One month post-admission, the patient was transferred for all day respiratory management with NPPV. One year after the onset, the patient's vital capacity improved to 1960 mL. The patient engaged in activities involving changes in body position or transfer training, gait training, and activities of daily living training with NPPV. Following training, the patient could independently propel a wheelchair and walk 40 m using a walker. The patient could also eat, brush his teeth using a self-help device, and independently wipe their face.Conclusion：Respiratory dysfunction in this case was a ventilatory impairment resulting from respiratory muscle paralysis. Pulmonary rehabilitation for cervical spinal cord injury facilitates respiratory management with NPPV, improves respiratory condition, and reduces the amount of assistance.