Neuromuscular respiratory failure

A wide variety of neurologic disorders cause acute generalized weakness precipitating hospital admission and neurologic evaluation; serious dysfunction of the neuromuscular system also occurs in critically ill patients in the intensive care unit. Respiratory muscles are commonly affected in either case, leading to hypoventilation, hypercapnic respiratory failure, and the need for (or prolongation of) mechanical ventilation (MV). Closely monitoring patients with neuromuscular weakness is critical in recognizing early signs of respiratory failure and guiding the need for prompt ventilatory support; patientsmay also need to be intubated for airway protection. While intubated, these patients are at high risk for complications such as pneumonia that contribute to mortality. The proper recognition of the underlying neuromuscular disorder allows appropriate management and discussion of prognosis, including weaning from MV. Selective use of ancillary testing, such as EMG and nerve/muscle biopsy, may help when the clinical diagnosis is unclear and further assist with estimating recovery.