TY  - CHAP
M1  - Book, Section
TI  - Chapter 66. Neuromuscular Diseases Leading to Respiratory Failure
A1  - Marinelli, William A.
A1  - Leatherman, James W.
A2  - Hall, Jesse B.
A2  - Schmidt, Gregory A.
A2  - Wood, Lawrence D.H.
Y1  - 2005
N1  - 
T2  - Principles of Critical Care, 3e
AB  - Neuromuscular  disorders  (NMDs)  in  critical  care  may  be  divided  into  those  that  precipitate  admission  to  the  ICU  and  those  that  arise  during  ICU  management;  the  latter  are  much  more  common  and  significantly  influence  the  pace  and  extent  of  recovery  from  critical  illness.The  maximal  inspiratory  pressure  (MIP),  maximal  expiratory  pressure  (MEP),  vital  capacity  (VC),  and  qualitative  judgment  of  oropharyngeal  function  are  the  most  important  parameters  to  follow  in  patients  with  NMDs.An  effective  cough  is  unlikely  with  a  MEP  <40  cm  H2O  or  a  VC  <30  mL/kg.Sleep-related  deterioration  in  hypoventilation  and  hypoxemia  is  common  in  patients  with  respiratory  muscle  impairment.Many  patients  with  Guillain-Barré  syndrome  or  myasthenia  gravis  of  sufficient  severity  to  precipitate  ICU  admission  will  benefit  from  treatment  with  plasmapheresis  or  intravenous  immunoglobulin.Muscle  biopsy  is  useful  in  the  diagnosis  of  polymyositis,  mitochondrial  disease,  and  other  myopathies,  and  should  be  considered  when  electrophysiologic  and  other  testing  does  not  offer  a  clear  diagnosis  of  peripheral  neuropathy  or  myoneural  junction  diseases.Critical  illness  myopathy  and  neuropathy  should  be  considered  in  all  patients  with  protracted  critical  illness,  particularly  when  multisystem  organ  failure  has  been  present;  avoidance  of  paralytics,  appropriate  correction  of  the  metabolic  milieu,  early  physical  therapy,  and  measures  to  shorten  duration  of  mechanical  ventilation  may  help  ameliorate  the  impact  of  these  acquired  NMDs.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2023/10/04
UR  - accessmedicine.mhmedical.com/content.aspx?aid=2293033
ER  -