Respiratory Complications of Rapidly Progressive Neuromuscular Syndromes: Guillain-Barré Syndrome and Myasthenia Gravis

Abstract

Neuromuscular respiratory failure is a common complication of both the Guillain-Barré syndrome and myasthenia gravis. Several key pathophysiological mechanisms contribute to the spiral of respiratory insufficiency in these diseases, including inspiratory, expiratory, and bulbar muscle weakness. It is important to identify patients with impending respiratory failure early to avoid emergency intubations. Several clinical features and bedside pulmonary function tests (PFTs) are useful in guiding decisions about intubation. Weaning is initiated when respiratory muscles have recovered sufficiently, and again, PFT criteria are helpful. Intravenous immunoglobulin and plasmapheresis are the cornerstones of specific therapy for both illnesses when complicated by respiratory failure. Mortality and morbidity are dramatically increased by respiratory failure and are mainly due to associated medical complications. Optimal outcomes depend on avoidance of these and prompt implementation of immunomodulatory therapy.

Fulminant guillain-barré syndrome with myocarditis

“…[5] Weakness can develop acutely or subacutely and reaches a plateau, with subsequent spontaneous resolution of paralysis. The pace of progression to respiratory failure from the onset can be dramatic, leading to quadriparesis and the need for intubation over 24-48 h.[6] Facial nerve palsy is the most common form of cranial nerve involvement in GBS, occurring in at least 70% of patients. Bulbar and oculomotor nerves are less often affected, except in patients with the antiGQ1b antibody syndromes.…”

Single-Breath-Count Test: An Important Adjunct in the Triaging of Patients in a Mass-Casualty Incident Due to Botulism

“…13 A single breath count of <15 is consistent with significant impairment of the patient's vital capacity. 13 " 17 The SBCT is not meant to replace any of the usual triage tools that currently are contained in one's protocols or guidelines. Rather, it is meant to be an adjunct, another vital sign to augment the other parameters.…”

Estimation of lung vital capacity before and after coronary artery bypass grafting surgery: a comparison of incentive spirometer and ventilometry

“…After cardiac surgery, the impairment of VC has a multifactorial meaning and the restrictive pattern can last for more than 116 days, predisposing atelectasis and post operatory complications [8-16]. In order to obtain pulmonary volumes and capacities, spirometry and ventilometry are the most used techniques in clinical practice, nevertheless, both methods are very costly and not always available in hospitals [3,5,17-20].…”