Causes and Outcomes of Acute Neuromuscular Respiratory Failure

Intensive Care Medicine, 1999

Romanian Journal of Neurology

Acute respiratory failure (ARF) is a life-threatening condition that often results from the acute onset of neuromuscular disease (NMD) and often coexists with other cardiorespiratory conditions. For more than two decades, existing studies have shown that non-invasive ventilation (NIV) is the main ventilatory support and provides a good clinical outcome in ARF with various conditions, but its use in NMD patients with ARF is still limited. In patients with ARF, NIV can be initiated in fully awake patients with hemodynamically stable, without upper airway obstruction, and airway secretions can be overcome. Furthermore, expiratory positive airway pressure (EPAP) and inspiratory positive airway pressure (IPAP) settings with backup rates are recommended. Additionally, some studies have reported that the application of NIV in NMD with ARF can also be beneficial as a weaning strategy. Hence, further studies need to be conducted to generate evidence regarding the role of NIV in NMD patients ...

2014

showed in term of lower mortality, treatment failure, duration of ICU in several studies. Home mechanical noninvasive ventilation and MAC may result dramatic reduction in the need for hospitalization and a prolongation of life expectancy of these patients. To avoid the progression of respiratory failure an early identification of respiratory deterioration is needed, as such as prevention of acute episodes. So, especially in the progressive diseases, is very important to monitor respiratory status with periodic lung function tests. Any respiratory tract infection in neuromuscular disease could trigger acute respiratory failure so it is mandatory take any aggressive measures to prevent and treat this complication. Some of principal preventive measures include vaccination against Pneumococcus Pn. and influenza virus, early antibiotic treatment when bacterial infection is suspected, chest physiotherapy for removal airway secretions or mechanical assisted maneuvers to increase cough efficiency. In conclusion, a proactive, preventive approach is the key for optimal management acute respiratory problems in neuromuscular disorders.

2007

Neuromuscular diseases affect alveolar air exchange and therefore cause chronic respiratory failure. The onset of respiratory failure can be acute, as in traumas, or progressive (slow or rapid), as in amyotrophic lateral sclerosis, muscular dystrophies, diseases of the myoneural junction, etc. Respiratory muscle impairment also affects cough efficiency and, according to the current knowledge regarding the type of treatment available

Journal of Clinical Medicine

Background: The arterial blood gas (ABG) parameters of patients admitted to intensive care units (ICUs) with acute neuromuscular respiratory failure (NMRF) and non-NMRF have not been defined or compared in the literature. Methods: We retrospectively collected the initial ABG parameters (pH, PaCO2, PaO2, and HCO3) of patients admitted to ICUs with acute respiratory failure. We compared ABG parameter ranges and the prevalence of abnormalities in NMRF versus non-NMRF and its categories, including primary pulmonary disease (PPD) (chronic obstructive pulmonary disease, asthma, and bronchiectasis), pneumonia, and pulmonary edema. Results: We included 287 patients (NMRF, n = 69; non-NMRF, n = 218). The difference between NMRF and non-NMRF included the median (interquartile range (IQR)) of pH (7.39 (7.32–7.43), 7.33 (7.22–7.39), p < 0.001), PaO2 (86.9 (71.4–123), 79.6 (64.6–99.1) mmHg, p = 0.02), and HCO3 (24.85 (22.9–27.8), 23.4 (19.4–26.8) mmol/L, p = 0.006). We found differences in th...

Pulmonary Medicine, 2019

Respiratory muscle weakness is a major cause of morbidity and mortality in patients with neuromuscular diseases (NMDs). Respiratory involvement in NMDs can manifest broadly, ranging from milder insufficiency that may affect only sleep initially to severe insufficiency that can be life threatening. Patients with neuromuscular diseases exhibit very often sleep-disordered breathing, which is frequently overlooked until symptoms become more severe leading to irreversible respiratory failure necessitating noninvasive ventilation (NIV) or even tracheostomy. Close monitoring of respiratory function and sleep evaluation is currently the standard of care. Early recognition of sleep disturbances and initiation of NIV can improve the quality of life and prolong survival. This review discusses the respiratory impairment during sleep in patients with NMDs, the diagnostic tools available for early recognition of sleep-disordered breathing and the therapeutic options available for overall respirat...

Intensive Care Medicine, 2000

Objective: Prospectively to investigate the efficacy of non-invasive positive pressure ventilation (NPPV) combined with cricothyroid ªmini

Journal of Thoracic Disease, 2019

Archives of Neurology, 2004

To delineate and clarify neuromuscular disorders in patients with probable severe acute respiratory syndrome (SARS). Design: Case series with follow-up ranging from 3 weeks to 2 months.

Respiratory Medicine, 2011

Background: Respiratory failure is the most common cause of morbidity and mortality in patients with neuromuscular diseases (NMD). Non-invasive mechanical ventilation is considered highly effective for treating chronic respiratory failure. Perception and knowledge of risks associated with respiratory derangements may be underestimated. Objective: The aim of our study was to evaluate the association among respiratory function, general clinical disability and need of home mechanical ventilation (HMV) in patients with slowly progressive NMD admitted for the first time to dedicated respiratory outpatient clinics. Methods: Anthropometrics, lung function, respiratory muscle function, daytime blood gases data, and general clinical disability assessed by means of a clinical interview were recorded. Indication for HMV was an arterial CO 2 tension >45 mmHg and/or a vital capacity <50% predicted, and/or maximal inspiratory pressure <60 cmH 2 O. Results: Two out of 5 patients complained of dyspnoea during daily activity and dysphagia, while more than 1/3 had ineffective cough and speech difficulties. Two-third of the whole group were considered to need HMV. By applying one or more criteria for NMD diagnosis, great variability was found for indication to HMV. Clinical disability was inversely related to dynamic Abbreviations: ABGs, arterial blood gases; ALS, amyotrophic lateral sclerosis; BMI, body mass index; DMD, Duchenne muscular dystrophy; EMG, electromyography; FEV1, forced expiratory volume in one second; FIM, functional independence measure; FVC, forced vital capacity; GD, general clinical disability state; HMV, home mechanical ventilation; MIP, maximal inspiratory pressure; MEP, maximal expiratory pressure; NIV, non-invasive mechanical ventilation; NMD, neuromuscular diseases; OT, all other diagnosis; % pred, percentage of the predicted values; SMA, spinal muscular atrophies; UILDM, Unione Italiana Lotta alla Distrofia Muscolare; VC, vital capacity. (D. Fiorenza). a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / r m e d Respiratory Medicine (2010) xx, 1e8 + MODEL Please cite this article in press as: Fiorenza D, et al., Lung function and disability in neuromuscular patients at first admission to a respiratory clinic, Respiratory Medicine (2010),