Diagnosis and treatment of neuromuscular causes of acute respiratory failure

The management of neuromuscular causes of respiratory failure involves two separate clinical problems: the appropriate neurologic diagnosis in a patient with acute respiratory failure (ARF) and the decision as to when to intubate electively a patient with a known neurologic disease prior to the development of ARF. In both situations, a thorough history and physical examination are of the utmost value. In addition, arterial blood gas (ABG) analysis will be beneficial in the former situation, while monitoring respiratory parameters is helpful in the latter. In this paper, we will first outline the functional neuroanatomy of respiration. Next, we will discuss the clinical signs and symptoms of respiratory failure. This will be followed by the laboratory assessment of respiratory failure. There will be a brief discussion of the pharmacology of respiratory muscle failure. Finally, we will outline the various disorders that may either present or be complicated by ARF.