Practical approach to respiratory emergencies in neurological diseases
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REVIEW ARTICLE
Practical approach to respiratory emergencies in neurological diseases Fabrizio Racca 1 & Andrea Vianello 2 & Tiziana Mongini 3 & Paolo Ruggeri 4 & Antonio Versaci 5 & Gian Luca Vita 6 & Giuseppe Vita 6,7 Received: 1 October 2019 / Accepted: 15 November 2019 # Fondazione Società Italiana di Neurologia 2019
Abstract Many neurological diseases may cause acute respiratory failure (ARF) due to involvement of bulbar respiratory center, spinal cord, motoneurons, peripheral nerves, neuromuscular junction, or skeletal muscles. In this context, respiratory emergencies are often a challenge at home, in a neurology ward, or even in an intensive care unit, influencing morbidity and mortality. More commonly, patients develop primarily ventilatory impairment causing hypercapnia. Moreover, inadequate bulbar and expiratory muscle function may cause retained secretions, frequently complicated by pneumonia, atelectasis, and, ultimately, hypoxemic ARF. On the basis of the clinical onset, two main categories of ARF can be identified: (i) acute exacerbation of chronic respiratory failure, which is common in slowly progressive neurological diseases, such as movement disorders and most neuromuscular diseases, and (ii) sudden-onset respiratory failure which may develop in rapidly progressive neurological disorders including stroke, convulsive status epilepticus, traumatic brain injury, spinal cord injury, phrenic neuropathy, myasthenia gravis, and Guillain–Barré syndrome. A tailored assistance may include manual and mechanical cough assistance, noninvasive ventilation, endotracheal intubation, invasive mechanical ventilation, or tracheotomy. This review provides practical recommendations for prevention, recognition, management, and treatment of respiratory emergencies in neurological diseases, mostly in teenagers and adults, according to type and severity of baseline disease. Keywords Neurological diseases . Respiratory failure . Hypercapnia . Hypoxemia . Invasive mechanical ventilation . Noninvasive ventilation
Fabrizio Racca and Andrea Vianello contributed equally to this work. * Giuseppe Vita [email protected] 1
Department of Anaesthesia and Intensive Care, Sant’Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
2
Respiratory Pathophysiology Division, University of Padua, Padua, Italy
3
Neuromuscular Center, Department of Neurosciences, University of Turin, Turin, Italy
4
Unit of Pneumology, Department BIOMORF, University of Messina, Messina, Italy
5
Intensive Care Unit, AOU Policlinico “G. Martino”, Messina, Italy
6
Nemo Sud Clinical Centre for Neuromuscular Disorders, Messina, Italy
7
Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
Abbreviations ALS Amyotrophic lateral sclerosis ARDS Acute respiratory distress syndrome ARF Acute respiratory failure AT Ataxia telangiectasia CNS Central nervous system CPEF Cough peak expiratory flow DM Dermatomyositis DM1 Myotonic dystrophy type 1 DMD Duchenne muscular dystrophy
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