Subscribe to RSS
DOI: 10.1055/s-2003-40757
Warning Signs of Imminent Respiratory Failure in Neurological Patients
Publication History
Publication Date:
21 July 2003 (online)
![](https://www.thieme-connect.de/media/sin/200301/lookinside/thumbnails/10.1055-s-2003-40757-1.jpg)
ABSTRACT
Critically ill neurological patients often need ventilatory assistance. After acute central nervous system insults, the inability to protect the airway and impaired central respiratory drive can only be managed with endotracheal intubation and mechanical ventilation. In patients with acute or worsening neuromuscular disorders, diaphragmatic failure and pronounced bulbar weakness may necessitate intubation to assist in the work of breathing or to prevent upper airway obstruction. Simple respiratory function tests performed at the bedside should be used to monitor patients with progressive neuromuscular respiratory insufficiency. Noninvasive positive pressure ventilation plays an important role in the management of respiratory failure in patients with neuromuscular respiratory failure, and its indications may be expanded in the future.
KEYWORDS
Respiratory failure - neuromuscular - ventilation - stroke
REFERENCES
- 1 Wijdicks E FM. The Clinical Practice of Critical Care Neurology. Philadelphia: Lippincott-Raven 1997
- 2 Plum F, Posner J B. The Diagnosis of Stupor and Coma. 3rd ed. Philadelphia: FA Davis Co. 1980
- 3 Becattini C, Agnelli G. Risk factors for adverse short-term outcome in patients with pulmonary embolism. Thromb Respiratory . 2001; 103 V239-V244
- 4 Adams Jr P H. Emergent use of anticoagulation for treatment of patients with ischemic stroke. Stroke . 2002; 33 856-861
- 5 Mazzone C, Chiodo G, Sandercock P, Miccio M, Salvi R. Physical methods for preventing deep vein thrombosis in stroke (Cochrane Review). Cochrane Database Syst Rev 2002;CD001922.
- 6 Kelly J, Rudd A, Lewis R, Hunt B J. Venous thromboembolism after acute stroke. Stroke . 2001; 32 262-267
- 7 Steiner T, Mendoza G, De Georgia M, Schellinger P, Holle R, Hacke W. Prognosis of stroke patients requiring mechanical ventilation in a neurological critical care unit. Stroke . 1997; 28 711-715
- 8 Wijdicks E FM, Scott J P. Causes and outcome of mechanical ventilation inpatients with hemispheric ischemic stroke. Mayo Clin Proc . 1997; 72 210-213
- 9 Bushnell C D, Phillips-Bute B G, Laskowitz D T, Lynch J R, Chilukuri V, Borel C O. Survival and outcome after endotracheal intubation for acute stroke. Neurology . 1999; 52 1374-1381
- 10 Gujjar A R, Deibert E, Manno E M, Duff S, Diringer M N. Mechanical ventilation for ischemic stroke and intracerebral hemorrhage: indications, timing, and outcome. Neurology . 1998; 51 447-451
- 11 Santoli F, De Jonghe B, Hayon J, Tran B. Mechanical ventilation I: patients with acute ischemic stroke, survival and outcome at one year. Intensive Care Med . 2001; 27 1141-1146
- 12 Mayer S A, Copeland D, Bernardini G L. et al . Cost and outcome of mechanical ventilation for life-threatening stroke. Stroke . 2000; 31 2346-2353
- 13 Berrouschot J, Rossler A, Koster J, Schneider D. Mechanical ventilation in patients with hemispheric ischemic stroke. Crit Care Med . 2000; 28 2956-2961
- 14 el-Ad B, Bornstein N M, Fuchs P, Korczyn A D. Mechanical ventilation in stroke patients: is it worthwhile?. Neurology . 1996; 47 657-659
- 15 Rabinstein A A, Wijdicks E FM. Consequences of prolonged ventilatory assistance and tracheostomy in survivors of acute stroke (submitted). Cerebrovasc Dis . 2002;
- 16 Chokroverty S. Sleep-disordered breathing in neuromuscular disorders: a condition in search of recognition. Muscle Nerve . 2001; 24 451-455
- 17 Ropper A H, Kehne S M. Guillain-Barré syndrome: management of respiratory failure. Neurology . 1985; 35 1662-1665
- 18 Ropper A H, Wijdicks E FM, Truax B T. Guillain-Barré Syndrome. Philadelphia: FA Davis Co. 1991
- 19 Hahn A F. The challenge of respiratory dysfunction in Guillain-Barré syndrome. Arch Neurol . 2001; 58 871-872
- 20 Lawn N D, Fletcher D D, Henderson R D, Wolter T D, Wijdicks E FM. Anticipating mechanical ventilation in Guillain-Barré syndrome. Arch Neurol . 2001; 58 893-898
- 21 Cooperman L H. Succinylcholine-induced hyperkalemia in neuromuscular disease. JAMA . 1970; 213 1867-1871
- 22 Laskowitz D T, Borel C O. Respiratory and bulbar dysfunction in neurologic disease. In: Miller DH, Raps EC, eds. Critical Care Neurology Boston: Butterworth-Heinemann 1999
- 23 Winer J B, Hughes R A, Greenwood R J, Perkin G D, Healy M J. Prognosis in Guillain-Barré syndrome. Lancet . 1985; 1 1202-1203
- 24 Fletcher D D, Lawn N D, Wolter T D, Wijdicks E FM. Long-term outcome in patients with Guillain-Barré syndrome requiring mechanical ventilation. Neurology . 2000; 54 2311-2315
- 25 Hund E F, Borel C O, Cornblath D R, Hanley D F, McKhann G M. Intensive management and treatment of severe Guillain-Barré syndrome. Crit Care Med . 1993; 21 433-446
- 26 Putman M T, Wise R A. Myasthenia gravis and upper airway obstruction. Chest . 1996; 109 400-404
- 27 Schmidt-Nowara W W, Marder E J, Feil P A. Respiratory failure in myasthenia gravis due to vocal cord paresis. Arch Neurol . 1984; 41 567-568
- 28 O'Riordan J I, Miller D H, Mottershead J P, Hirsch N P, Howard R S. The management and outcome of patients with myasthenia gravis treated acutely in a neurological intensive care unit. Eur J Neurol . 1998; 5 137-142
- 29 Rieder P, Louis M, Jolliet P, Chevrolet J C. The repeated measurement of vital capacity is a poor predictor of the need for mechanical ventilation in myasthenia gravis. Intensive Care Med . 1995; 21 663-668
- 30 Mier-Jedrzejowicz A K, Brophy C, Green M. Respiratory muscle function in myasthenia gravis. Am Rev Respir Dis . 1988; 138 867-873
- 31 Zifko U A, Nicolle M W, Grisold W, Bolton C F. Repetitive phrenic nerve stimulation in myasthenia gravis. Neurology . 1999; 53 1083-1087
- 31a Rabinstein A A, Wijdicks E FM. BiPap in acute respiratory failure due to myasthenic crisis may prevent intubation. Neurology . 2002; 59 1647-1649
- 32 Gracey D R, Divertie M B, Howard Jr M F. Mechanical ventilation for respiratory failure in myasthenia gravis: two-year experience with 22 patients. Mayo Clin Proc . 1983; 58 597-602
- 33 Kaplan L M, Hollander D. Respiratory dysfunction in amyotrophic lateral sclerosis. Clin Chest Med . 1994; 15 675-681
- 34 Fromm G B, Wisdom P J, Block A J. Amyotrophic lateral sclerosis presenting with respiratory failure: diaphragmatic paralysis and dependence on mechanical ventilation in two patients. Chest . 1977; 71 612-614
- 35 Meyrignac C, Poirier J, Degos J D. Amyotrophic lateral sclerosis presenting with respiratory insufficiency as the primary complaint: clinicopathological study of a case. Eur Neurol . 1985; 24 115-120
- 36 Hill R, Martin J, Hakim A. Acute respiratory failure in motor neuron disease. Arch Neurol . 1983; 40 30-32
- 37 de Carvalho, Matias T, Coelho F, Evangelista T, Pinto A, Luis M L. Motor neuron disease presenting with respiratory failure. J Neurol Sci . 1996; 139 117-122
- 38 Varrato J, Siderowf A, Damiano P, Gregory S, Feinberg D, McCluskey L. Postural change of forced vital capacity predicts some respiratory symptoms in ALS. Neurology . 2001; 57 357-359
- 39 NHLBI Workshop summary. Respiratory muscle fatigue: report of the Respiratory Muscle Fatigue Workshop Group. Am Rev Respir Dis . 1990; 142 474-480
- 40 Similowski T, Fleury B. Launois S, Cathala HP, Bouche P, Derenne JP. Cervical magnetic stimulation: a new painless method for bilateral phrenic nerve stimulation in conscious humans. J Appl Physiol . 1989; 67 1311-1318
- 41 Mador M J, Khan S, Kufel T J. Bilateral anterolateral magnetic stimulation of the phrenic nerves can detect diaphragmatic fatigue. Chest . 2002; 121 452-458
- 42 Fallat R J, Jewitt B, Bass M, Kamm B, Norris Jr H F. Spirometry in amyotrophic lateral sclerosis. Arch Neurol . 1979; 36 74-80
- 43 Black L F, Hyatt R E. Maximal static respiratory pressures in generalized neuromuscular disease. Am Rev Respir Dis . 1971; 103 641-650
- 44 Miller R G, Rosenberg J A, Gelinas D F. et al . Practice parameter: the care of the patient with amyotrophic lateral sclerosis (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology: ALS Practice Parameters Task Force. Neurology . 1999; 52 1311-1323
- 45 Sivak E D, Shefner J M, Mitsumoto H, Taft J M. The use of non-invasive positive pressure ventilation (NIPPV) in ALS patients: a need for improved determination of intervention timing. Amyotroph Lateral Scler Other Motor Neuron Disord . 2001; 2 139-145
- 46 Bradley W G, Anderson F, Bromberg M. et al . Current management of ALS: comparison of the ALS CARE Database and the AAN Practice Parameter. The American Academy of Neurology. Neurology . 2001; 57 500-504
- 47 Lyall R A, Donaldson N, Fleming T. et al . A prospective study of quality of life in ALS patients treated with noninvasive ventilation. Neurology . 2001; 57 153-156
- 48 Schlamp V, Karg O, Abel A, Schlotter B, Wasner M, Borasio G D. Noninvasive intermittent self-ventilation as a palliative measure in amyotrophic lateral sclerosis. Nervenarzt . 1998; 69 1074-1082
- 49 Kleopa K A, Sherman M, Neal B, Romano G J, Heiman- Patterson T. Bipap improves survival and rate of pulmonary function decline in patients with ALS. J Neurol Sci . 1999; 164 1-2
- 50 Aboussouan L S, Khan S U, Meeker D P, Stelmach K, Mitsumoto H. Effect of noninvasive positive-pressure ventilation on survival in amyotrophic lateral sclerosis. Ann Intern Med . 1997; 128 601-602
- 51 Pinto A C, Evangelista T, Carvalho M, Alves M A, Sales Luís L M. Respiratory assistance with non-invasive ventilator (Bipap) in NMD/ALS patients: survival rates in a controlled trial. J Neurol Sci . 1995; 129 19-26
- 52 Hill N S. Noninvasive ventilation: does it work, for whom, and how?. Am Rev Respir Dis . 1993; 147 1050-1055
- 53 Boitano L J, Jordan T, Benditt J O. Noninvasive ventilation allows gastrostomy tube placement in patients with advanced ALS. Neurology . 2001; 56 413-414
- 54 Gregory S, Siderowf A, Golaszewski A L, McCluskey L. Gastrostomy insertion in ALS patients with low vital capacity: respiratory support and survival. Neurology . 2002; 58 485-487