This chapter explores the approach to acute neuromuscular weakness in the ICU, as well as selected disorders. As with any acute presentation, an organized approach is essential. Understanding the limitations of various tests is also critical (since there is considerable confusion about this).
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The IBCC chapter is located 👉 here.
- The podcast & comments are below.
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Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.
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id like to add snake envenomation and necrotizing myopathy to the ddx list :). Currently have a *hypothetical* patient presented like a GBS v MG patient transfer from OSH for “neurology eval”… cytoalbuminologic dissociation, high protein in csf, cauda equina nerve root uptake on initial C+ L spine MRI, diffusely weak, some LE reflexes were weakly present, ptosis w + ice pack test, bulbar weakness…massive NM w/u negative, neg GM ab, neg musk, neg AchRab, neg infectious w/u but ID would not approve botulism testing (patient had no wounds, interestingly enough his dad did home can food but patient never… Read more »
This chapter mentions that blood gas measurement is useless for neuromuscular patients in possible acute respiratory failure, which I don’t think is true. If a patient is given oxygen, it can mask symptoms of hypercapnic respiratory failure or distress and depress the respiratory drive. For anyone with possible respiratory failure or who could go into respiratory failure, arterial blood gas testing is the gold standard I’ve been told. Noninvasive CO2 monitoring can also be used. You mention nocturnal BiPAP, which is enough for less severe cases, but it can progress into needing BiPAP full time. A trach isn’t necessarily required… Read more »