Supportive measures

Supportive care involves careful monitoring for respiratory compromise and autonomic instability. It also involves preventing and treating the complications of immobility and altered pharyngeal and thoracic muscle function. Thus patients need to be assessed frequently for progression of thoracic muscle weakness. Measurement of vital capacity several times daily is a useful guide. It is important to remember that arterial blood gases are not very useful markers as hypoxia and hypercarbia are late signs of respiratory failure. Monitoring patients closely for impending respiratory failure is crucial even if they have minimal weakness, since thoracic muscle involvement may develop and progress very suddenly. Sinus tachycardia due to autonomic instability is frequent. Any other arrhythmia or blood pressure instability should be another indication for ICU admission. Thromboembolic disease prophylaxis and aggressive treatment of any thrombotic complications are important. Aspiration pneumonia is common, and needs appropriate preventive and treatment strategies.

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