Practical approach to management of respiratory complications in neurological disorders

Abstract

Patients with certain neurological diseases are at increased risk of developing chest infections as well as respiratory failure due to muscular weakness. In particular, patients with certain neuromuscular disorders are at higher risk. These conditions are often associated with sleep disordered breathing. It is important to identify patients at risk of respiratory complications early in the course of their disease, although patients with neuromuscular disorders often present in the acute setting with respiratory involvement. This review of the respiratory complications of neurological disorders, with a particular focus on neuromuscular disorders, explores why this happens and looks at how to recognize, investigate, and manage these patients effectively.

Keywords: respiratory failure; respiratory muscle weakness.

Figure 1

Effect of progressive respiratory muscle weakness on nocturnal and diurnal ventilation. Note: Reproduced with permission from the American College of Chest Physicians. Simonds A. Recent advances in respiratory care for neuromuscular disease. Chest. 2006;130:1879–1886. Abbreviation: REM, rapid eye movement.

Figure 2

Suggested pathway for investigating and managing patients with a neuromuscular disorder and respiratory insufficiency. Notes: *Depends on oxygen saturations and clinical suspicion of daytime hypercapnoea. Adapted from Upinder K, Dhand K, Dhand. Sleep disorders in neuromuscular diseases. Curr Opin Pulm Med. 2006;12:402–408. Abbreviations: FVC, forced vital capacity; NMD, neuromuscular disorder; OSA, obstructive sleep apnea; CPAP, continuous positive airways pressure; NIV, noninvasive ventilation; SDB, sleep-disordered breathing.