1/6. Acute neuromuscular respiratory failure after ICU discharge. Report of five patients.OBJECTIVE: To describe a syndrome of acute neuromuscular respiratory failure (NM-ARF) caused by ICU-acquired acute myopathy and neuropathy. DESIGN: Case series. SETTING: General Regional University Hospital in Brescia, italy. patients: Five adult patients with NM-ARF after prolonged ICU stay and successful weaning from the ventilator and ICU discharge. INTERVENTIONS: None. MEASUREMENTS: Clinical signs of NM-ARF, electroneurography and electromyography (ENMG) of peripheral nerves and muscles, and functional assessment of respiratory muscles. RESULTS: NM-ARF was diagnosed at the time of (one case), or 1-3 days after, ICU discharge. Limb weakness alarmed the physicians, while the signs of the NM-ARF were initially undetected. In the first observed case the acute respiratory failure was near fatal, and necessitated ICU readmission, while in the other cases 2 weeks of aggressive chest physiotherapy permitted resolution of the respiratory failure. history, clinical course and ENMG indicated the diagnosis of critical illness myopathy and neuropathy (CRIMYNE). Three patients recovered fully, while two had persisting evidence of axonal polyneuropathy several months after the onset. CONCLUSIONS: Critically ill patients with prolonged ICU stay, sepsis and MOF are at great risk of developing CRIMYNE, which in turn may be responsible for NM-ARF. This latter complication may arise after resolution of the respiratory and cardiac dysfunctions and successful weaning from the ventilator. As NM-ARF may cause unplanned ICU readmission or even unexpected death, strict clinical surveillance and monitoring of respiratory muscle function is recommended after discharge to the general ward of patients with proven NM-ARF. Early intensive chest physiotherapy can resolve the condition.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Acute diaphragmatic paralysis caused by chest-tube trauma to phrenic nerve.A 3 1/2-year-old child developed unilateral diaphragmatic paralysis after chest drain insertion. Plain chest X-ray demonstrated paravertebral positioning of the chest-tube tip, and magnetic resonance imaging revealed hematomas in the region of the chest-tube tip and the phrenic nerve fibers. The trauma to the phrenic nerve was apparently secondary to malposition of the chest tube. This is a rare complication and has been reported mainly in neonates. Radiologists should notify the treating physicians that the correct position of a chest drain tip is at least 2 cm distant from the vertebrae.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. A case of frog breathing.Frog breathing (glossopharyngeal breathing) is a useful technique employed to increase ventilation when respiratory muscles are paralysed. It is a technique used by many patients with chronic poliomyelitis, yet many chest physicians and physiotherapists are unfamiliar with this breathing maneuver. Glossopharyngeal breathing coordinates movements of the tongue, cheeks and pharynx to force air from the mouth into the lungs. We report a case of glossopharyngeal breathing, demonstrating a 3 fold increase in vital capacity in a subject with chronic poliomyelitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. Bilateral diaphragmatic paralysis and related respiratory complications in a patient with west nile virus infection.The case report is presented of a patient with west nile virus infection and ventilator dependent respiratory failure in whom bilateral diaphragmatic paralysis developed. If the prevalence of west nile virus infection continues to rise, recognition of diaphragmatic paralysis and related respiratory complications will become increasingly important to the pulmonary/critical care physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. An overlooked association of brachial plexus palsy: diaphragmatic paralysis.Diaphragmatic paralysis in newborns is related to brachial plexus palsy. It can be overlooked if thorough examination isn't done. We present a two-weeks-old baby with a birth weight of 3800 grams who had a left-sided brachial plexus palsy and torticollis with an undiagnosed left diaphragmatic paralysis even though he was examined by different physicians several times. The role of physical examination, the chest x-rays of patients with brachial paralysis and the treatment modalities of diaphragmatic paralysis due to obstetrical factors are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. The guillain-barre syndrome: pulmonary-neurologic correlations.In a retrospective analysis of 40 hospitalized patients with the guillain-barre syndrome (GBS), we related the use and outcome of assisted ventilation to specific quantitative details of the neurologic illness. Two patients had an unusually prolonged course: they were ventilated for 374 and 396 days before successful weaning. The other 38 patients were similar in most respects to those in previously reported series. Sixteen ventilated patients were hospitalized 56.6 /- 10.6 (mean /- S.E.M.) days, were ventilated 27.9 /- 6.5 days, and had primarily pulmonary complications. There were 4 deaths during ventilation, and 9 of 13 survivors (69%) had a short-term excellent functional neurologic outcome. attention to the neurologic details of the course of illness may spare some patients from tracheostomy. Twenty-two patients not requiring respirator support suffered distinctly less severe neuromuscular impairment with minimal cranial neuropathy, had no occurrence of pneumonia, and were discharged after 19.1 /- 4.6 days. Eighty-one percent had an excellent functional outcome. The wide range of manifestations and severity of patients with GBS requires the attending physician to be flexible in dealing with each case and not make management decisions arbitrarily, by reference to a hypothetical "typical case."- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |