Acute neuromuscular respiratory paralysis.

Hughes, Richard A.; Bihari, D.

doi:10.1136/jnnp.56.4.334

Cited by 61 publications

(53 citation statements)

References 77 publications

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“…Interestingly, all results from volitional tests were comparable in diabetic patients and controls, indicating that global respiratory neuromuscular function is preserved in these patients. This is in line with previous studies [9] and supports the clinical observation that chronic respiratory failure caused by respiratory muscle weakness is unlikely in diabetic patients [33]. However, Fig.…”

Section: Discussionsupporting

confidence: 93%

Diabetic polyneuropathy is associated with respiratory muscle impairment in type 2 diabetes

et al. 2007

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Aims/hypothesis Diabetes has a major negative effect on intensive care unit outcome. This has been partly attributed to impaired respiratory neuromuscular function. However, data on respiratory neuromuscular involvement in diabetes are lacking. This study therefore aimed to assess respiratory neuromuscular function related to diabetic polyneuropathy in patients with type 2 diabetes. Methods Respiratory neuromuscular function was assessed by the use of volitional tests and twitch mouth (TwPmo) and twitch transdiaphragmatic (TwPdi) pressures during non-volitional bilateral anterior magnetic phrenic nerve stimulation in 21 male type 2 diabetic patients without pulmonary disease and in 23 healthy, well-matched controls (forced expiratory volume in 1 s 103±11 vs 103±12% predicted; p=0.9). Results Both volitionally assessed maximal inspiratory and expiratory mouth pressures, and sniff nasal and transdiaphragmatic pressures were comparable between diabetic patients and controls (p>0

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Section: Discussionsupporting

confidence: 93%

Diabetic polyneuropathy is associated with respiratory muscle impairment in type 2 diabetes

et al. 2007

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“…The incidence of bradycardia was 44% in quadriplegic or ventilated patients, compared with 2% to 7% in those who were less severely disabled [6]. However, we [11] and others [8,10] have described patients who suffered from serious bradyarrhythmias before needing ventilation and during weaning from the ventilator. Some patients were only moderately affected by the disease.…”

Section: Serious Bradyarrhythmias and Clinical Characteristicsmentioning

confidence: 98%

“…Serious bradyarrhythmias have been thought to occur only in severely disabled patients, mainly in those who needed artificial ventilation [8]. In the series of Winer and Hughes, only those patients requiring mechanical ventilation developed serious arrhythmias [7].…”

Section: Serious Bradyarrhythmias and Clinical Characteristicsmentioning

confidence: 99%

“…In particular, vagal overreactivity may cause serious bradyarrhythmias ranging from bradycardia to asystole, which account for a significant number of deaths [5]. It is generally believed that these bradyarrhythmias occur only in severely disabled patients, mainly in patients requiring mechanical ventilation [6][7][8][9]. However, they also have been described in cases without mechanical ventilation and even in less severely affected patients [8,10,11]..Early recognition of these potentially life-threatening dysrhythmias is crucial for the initiation of appropriate preventive therapy such as external cardiac pacemakers or monitoring on the intensive care unit (ICU).…”

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confidence: 99%

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Detection of serious bradyarrhythmias in Guillain-Barré syndrome: Sensitivity and specificity of the 24-hour heart rate power spectrum

Flachenecker

Lem²,

Müllges

et al. 2000

Clinical Autonomic Research

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This study was undertaken to determine the nature of bradyarrhythmic events and their relationship to motor disability, disease stages and tachycardia in patients with Guillain-Barré syndrome, and to investigate the potential of the 24-hour heart rate power spectrum (HRPS) for the detection of serious bradyarrhythmias in individual patients. Thirty-five consecutive patients with Guillain-Barré syndrome who were admitted to the authors' intensive care unit were studied. In all patients, the heart rate was continuously recorded during the early stages of the disease, averaged at 1-minute intervals, and stored for 1 to 87 days. The HRPS (n = 556, 16 +/- 19 per patient; median, 9) was calculated by Fourier analysis of 24-hour recordings and logarithmically transformed. The slope was estimated by regression analysis of log (power) on log (frequency) between 10(-4) and 4 x 10(-3) Hz, showing an inverse power law behavior in all 556 HRPSs. Eleven patients (31%) had serious bradyarrhythmias. Most of these patients were not dependent on mechanical ventilation, with 3 of 11 patients (27%) still being able to walk more than 5 meters. Sustained tachycardia occurred less frequently in patients with than in those without bradyarrhythmias. The combination of the slope of the power law regression line and the log (power) at 10(-4) Hz (log P4) of the 24-hour HRPS correctly identified 8 of 11 bradyarrhythmic patients (sensitivity 73%) and 16 of 22 patients with Guillain-Barré syndrome who did not have bradyarrhythmias (specificity 73%). All bradyarrhythmic patients could be detected in the subgroup of patients without sustained tachycardia. The 24-hour HRPS is a powerful predictor of serious autonomic complications in patients with Guillain-Barré syndrome and may help to identify patients at risk of potentially life-threatening arrhythmias.

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“…Neuromuscular junction blockade was rarely noted. 46 Other disorders causing neuromuscular weakness that sometimes leads to ICU admission resulting from ventilatory failure or airway collapse [47][48][49][50][51][52][53][54][55] are shown in Table 1. These conditions may be important causes of prolonged ventilator dependency.…”

Section: Spectrum Of Neuromuscular Disorders In the Intensive Care Unitmentioning

confidence: 99%

Neuromuscular Disorders in Critically Ill Patients: Review and Update

Lacomis

2011

Journal of Clinical Neuromuscular Disease

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Neuromuscular disorders that are diagnosed in the intensive care unit (ICU) usually cause substantial limb weakness and contribute to ventilatory dysfunction. Although some lead to ICU admission, ICU-acquired disorders, mainly critical illness myopathy (CIM) and critical illness polyneuropathy (CIP), are more frequent and are associated with considerable morbidity. Approximately 25% to 45% of patients admitted to the ICU develop CIM, CIP, or both. Their clinical features often overlap; therefore, nerve conduction studies and electromyography are particularly helpful diagnostically, and more sophisticated electrodiagnostic studies and histopathologic evaluation are required in some circumstances. A number of prospective studies have identified risk factors for CIP and CIM, but their limitations often include the inability to separate CIM from CIP. Animal models reveal evidence of a channelopathy in both CIM and CIP, and human studies also identified axonal degeneration in CIP and myosin loss in CIM. Outcomes are variable. They tend to be better with CIM, and some patients have longstanding disabilities. Future studies of well-characterized patients with CIP and CIM should refine our understanding of risk factors, outcomes, and pathogenic mechanisms, leading to better interventions.

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Acute neuromuscular respiratory paralysis.

Cited by 61 publications

References 77 publications

Diabetic polyneuropathy is associated with respiratory muscle impairment in type 2 diabetes

Diabetic polyneuropathy is associated with respiratory muscle impairment in type 2 diabetes

Detection of serious bradyarrhythmias in Guillain-Barré syndrome: Sensitivity and specificity of the 24-hour heart rate power spectrum

Neuromuscular Disorders in Critically Ill Patients: Review and Update

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