Use of Noninvasive Ventilation with Volume-Assured Pressure Support in Neuralgic Amyotrophy with Bilateral Diaphragmatic Paralysis

Abstract

Neuralgic Amyotrophy (NA) is a rare, acute onset inflammatory brachial plexopathy that frequently presents with acute pain followed by shoulder girdle muscle weakness. Phrenic nerve involvement affecting the diaphragms occurs in 7-10% of cases. We present the case of a 52-year-old man with neuralgic amyotrophy with phrenic nerve involvement and bilateral diaphragmatic paralysis with marked respiratory symptoms and sleep hypoventilation, who was treated with non-invasive ventilation with volume assured pressure support mode. By 21 months post disease onset, the patient had experienced marked improvement in orthopnea, sleep quality and functional status. This is the first reported case of the use of this mode of noninvasive ventilation in neuralgic amyotrophy.

Effect of Using Multimodality Chest Physiotherapy on Myasthenia Gravis Patients' Clinical Outcomes

“…Ventilatory muscle failure led to hypoventilation and inability to meet respiratory demand (Webb & Macintyre, 2016). This can also interpreted due to patients with myasthenia gravis have weak respiratory muscles that lead to respiratory failure because of alveolar hypoventilation, deteriorating respiratory muscle fatigue, and the existence of micro atelectasis in the bases of the lungs (Diaz-Abad et al, 2019). Throughout the observation days, group B displayed less respiratory distress symptoms than group A, including diaphoresis, restlessness, and the use of auxiliary muscles.…”

Treatment Approaches to Myasthenia Gravis and Obstructive Sleep Apnea: Case Report

“…[2][3][4][5] In some cases, patients also present with hypoventilation, of different degrees of severity. 6 The relevance of an association with sleep-disordered breathing (SDB) is based on the early observation that MG patients frequently died of respiratory failure in the early morning hours, before the intervention of intensive care medicine. Indeed, several previous reports document an increased prevalence of SDB in patients with MG. 3 The most common type of SDB is OSA, which is thought to be particularly prevalent in patients with neuromuscular diseases.…”

“…2 3 4 5 In some cases, patients also present with hypoventilation, of different degrees of severity. 6…”