Acute Neuromuscular Disorders

Latest Updates

September 4, 2020

  • Updated Table 4: Factors associated with the need for intubation in patients with neuromuscular respiratory failure
  • Information added: Isolated cases of GBS have been described in association with SARS-CoV2 infection, but whether infection with SARS-CoV2 may increase the risk of GBS remains currently undetermined.
  • Information added: Growing evidence indicates that GBS can be triggered by biological agents, and in particular by checkpoint inhibitors, such as ipilimumab and nivolumab.
  • Information added: Tracheostomy performed during the first 7 days from initiation of mechanical ventilation was not associated with lower morbidity or mortality on a nationwide observational study conducted in Japan.
  • Information added: Manifestations of dysautonomia can be observed in nearly 40% of patients hospitalized with GBS.
  • Information added: The safety and efficacy of eculizumab, a monoclonal antibody against the complement protein C5, for the treatment of patients with GBS was tested in a phase 2b trial (JET_GBS Study) in Japan. In a small cohort (n=34), eculizumab was safe but did not affect the proportion of patients able to walk independently at 4 weeks.
  • Information added:Myasthenic crisis can occur after thymectomy, an evidence-proven treatment for patients with generalized MG. Risk factors for the occurrence of myasthenic crisis after thymectomy include a previous crisis, thymoma, and bulbar symptoms.
  • Information added: Non-invasive ventilation may be sufficient in nearly 40% of patients with myasthenic crisis.
  • Information added: Although the incidence of CIMN in surivors of ARDS related to SARS-CoV2 infection (COVID19 pneumonia) remains to be studied, it can be anticipated to be high givne the prolonged duration of mechanical ventilation and frequent use of neuromuscular paralysus in these patients.
  • References updated.

February 21, 2019

  • Added Table 3: Common causes of erroneous spirometry values and possible solutions
  • Added Table 5: Factors associated with extubation success in patients with neuromuscular respiratory failure
  • Added Table 6: Neuromuscular diseases and their key diagnostic findings
  • Information added: A graded and individualized approach to mobilization in a multidisciplinary manner with nursing, physical and occupational therapy, and physiatrists is ideal in regards to early patient mobilization Information added: Atropine should be readily available for patients with bradyarrhythmias, and some severe symptomatic cases may require pacing
  • Reference added: Hocker S. Primary Acute Neuromuscular Respiratory Failure. Neurologic clinics 2017;35:707-21.
  • Reference added: D G-C, M T. Critical Care of Neuromuscular Disorders. Continuum 2-18;24:1753-75. Reference added: Walgaard C, Lingsma HF, van Doorn PA, van der Jagt M, Steyerberg EW, Jacobs BC. Tracheostomy or Not: Prediction of Prolonged Mechanical Ventilation in Guillain-Barre Syndrome. Neurocritical care 2017;26:6-13.
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