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Acute Neuromuscular Respiratory Failure

  • Katherine Schwartz
  • Christopher L. KramerEmail author
Chapter

Abstract

The clinician faces challenging diagnostic and treatment decisions when confronted with patients exhibiting oropharyngeal or respiratory weakness related to acute neuromuscular disorders. The primary concern is ascertaining the degree of neuromuscular respiratory failure and deciding whether there is a need for invasive or non-invasive ventilator support, or if close monitoring is required in the intensive care unit (ICU). Concomitantly, the search for the etiology driving the neuromuscular respiratory failure or the reason why a previously controlled neuromuscular condition worsened must be initiated. This chapter addresses these difficult questions the clinician faces when encountering a patient with neuromuscular respiratory failure by summarizing the clinical presentation, pathophysiology, and management of the condition. Additionally, the most common causes of primary neuromuscular respiratory failure, Guillain-Barré syndrome (GBS) and myasthenia gravis (MG), as well as the most common cause of secondary neuromuscular respiratory failure, critical illness neuromyopathy (CINM), will be discussed.

Keywords

Neuromuscular respiratory failure Guillain-Barré syndrome Acute inflammatory demyelinating polyneuropathy Myasthenia gravis Critical illness neuropathy Critical illness myopathy Amyotrophic lateral sclerosis Critical illness neuromyopathy Intensive care unit acquired weakness 

References

  1. 1.
    Wijdicks EFM. The neurology of acutely failing respiratory mechanics. Ann Neurol. 2017;81:485–94.CrossRefGoogle Scholar
  2. 2.
    Wijdicks EFM. Management of acute neuromuscular disorders. Handb Clin Neurol. 2017;140(3):229–37.CrossRefGoogle Scholar
  3. 3.
    Rabinstein AA. Acute neuromuscular respiratory failure. Continuum. 2015;21(5):1324–45.PubMedGoogle Scholar
  4. 4.
    Howard RS. Respiratory failure because of neuromuscular disease. Curr Opin Neurol. 2016;29(5):592–601.CrossRefGoogle Scholar
  5. 5.
    Irfan M, Selim B, Rabinstein AA, St. Louis EK. Neuromuscular disorders and sleep in critically ill patients. Crit Care Clin. 2015;31(3):533–50.CrossRefGoogle Scholar
  6. 6.
    Cabrera Serrano M, Rabinstein AA. Usefulness of pulmonary function tests and blood gases in acute neuromuscular respiratory failure. Eur J Neurol. 2012;19(3):452–6.CrossRefGoogle Scholar
  7. 7.
    Lawn ND, Fletcher DD, Henderson RD, Wolter TD, Wijdicks EF. Anticipating mechanical ventilation in Guillain-Barre syndrome. Arch Neurol. 2001;58(6):893–8.CrossRefGoogle Scholar
  8. 8.
    Walterspacher S, Kirchberger A, Lambeck J, et al. Respiratory muscle assessment in acute Guillain-Barre syndrome. Lung. 2016;194:821–8.CrossRefGoogle Scholar
  9. 9.
    Kramer CL, McCullough M, Wijdicks EF. Teaching video neuroimages: how to unmask respiratory strength confounded by facial diplegia. Neurology. 2015;84:e57–8.CrossRefGoogle Scholar
  10. 10.
    Boon AJ, O’Gorman C. Ultrasound in the assessment of respiration. J Clin Neurophysiol. 2016;33:112–9.CrossRefGoogle Scholar
  11. 11.
    Rabinstein AA. Non-invasive ventilation for neuromuscular respiratory failure: when to use and when to avoid. Curr Opin Crit Care. 2016;22(2):94–9.PubMedGoogle Scholar
  12. 12.
    Walgaard C, Lingsma HF, van Doorn PA, et al. Tracheostomy or not: prediction of prolonged mechanical ventilation in Guillain-Barre syndrome. Neurocrit Care. 2017;26:6–13.CrossRefGoogle Scholar
  13. 13.
    Lawn ND, Wijdicks EF. Post-intubation pulmonary function test in Guillain-Barre syndrome. Muscle Nerve. 2000;23:613–6.CrossRefGoogle Scholar
  14. 14.
    Caulfield AF, Flower O, Pineda JA, Uddin S. Emergency neurological life support: acute non-traumatic weakness. Neurocrit Care. 2017;27(Suppl 1):29–50.CrossRefGoogle Scholar
  15. 15.
    Cabrera Serrano M, Rabinstein AA. Causes and outcomes of acute neuromuscular respiratory failure. Arch Neurol. 2010;67(9):1089–94.CrossRefGoogle Scholar
  16. 16.
    Mier-Y-Teran-Romero L, Delorey MJ, Sejvar JJ, Johansson MA. Guillain–Barré syndrome risk among individuals infected with Zika virus: a multi-country assessment. BMC Med. 2018;16(1):67.CrossRefGoogle Scholar
  17. 17.
    Wolfe GI, Kaminski HJ, Aban IB, Minisman G, Kuo HC, et al; MGTX Study Group. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med. 2016;375(6):511–22.CrossRefGoogle Scholar
  18. 18.
    Seneviratne J, Mandrekar J, Wijdicks EF, Rabinstein AA. Predictors of extubation failure in myasthenic crisis. Arch Neurol. 2008;65(7):929–33.CrossRefGoogle Scholar
  19. 19.
    Sanders DB, Wolfe GI, Benatar M, et al. International consensus guidance for management of myasthenia gravis: executive summary. Neurology. 2016;87(4):419–25.CrossRefGoogle Scholar
  20. 20.
    Farmakidis C, Pasnoor M, Dimachkia MM, Barohn RJ. Treatment of myasthenia gravis. Neurol Clin. 2018;36:311–37.CrossRefGoogle Scholar
  21. 21.
    Iorio R, Damato V, Alboini PE, Evoli A. Efficacy and safety of rituximab for myasthenia gravis: a systematic review and meta-analysis. J Neurol. 2015;262(5):1115–9.CrossRefGoogle Scholar
  22. 22.
    Kramer CL. Intensive care unit-acquired weakness. Neurol Clin. 2017;35(4):723–36.CrossRefGoogle Scholar
  23. 23.
    Pun BT, Balas MC, Barnes-Daly MA, Thompson JL, Aldrich JM, Barr J, et al. Caring for critically ill patients with the ABCDEF bundle: results of the ICU liberation collaborative in over 15,000 adults. Crit Care Med. 2019;47(1):3–14.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of NeurologyUniversity of ChicagoChicagoUSA

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