Acute neuromuscular respiratory paralysis

RAC HUGHES, A McLUCKIE

This chapter reviews the recognition, diagnosis, and management of respiratory failure in acute neuromuscular disease. Respiratory failure requiring artificial ventilation occurs in about 20% of patients with Guillain-Barré syndrome (GBS), a small percentage of patients with myasthenia gravis and polymyositis, and also in acute rhabdomyolysis and a wide range of other less common disorders. Neuromuscular disorders are responsible for only a tiny proportion of admissions to most intensive care units, l0 (04%) of 2506 consecutive admissions to our own unit in the last two years. Of those patients, 75% required mechanical ventilation and 20% died in hospital. These figures exclude those patients who were admitted to the intensive care unit because of operation or systemic disease and then developed neuromuscular disease that caused respiratory failure or delayed weaning from mechanical ventilation.

Respiratory failure in the setting of chronic progressive neuromuscular disease, such as Duchenne muscular dystrophy and motor neuron disease, presents a challenging management problem beyond the scope of this chapter.

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