Journal of Clinical Respiratory Medicine

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Journal of Clinical Respiratory Medicine 44 7897 074717

Respiratory Muscle Weakness:

Respiratory muscle weakness that produces acute respiratory failure is a true neuromuscular emergency, and immediate intubation may be necessary. Weakness of the intercostal muscles and the diaphragm may result in carbon dioxide retention as a result of hypoventilation. Respiratory failure usually occurs around the time of surgery (eg, after thymectomy) or during the later stages of the disease. However, it can be a presenting feature of about 14-18% of patients with MG. Weak pharyngeal muscles may collapse in the upper airway. Careful monitoring of the respiratory status is necessary in the acute phase of MG. Negative inspiratory force, vital capacity, and tidal volume must be monitored carefully. Relying on pulse oximetry to monitor respiratory status can be dangerous. During the initial phase of the neuromuscular hypoventilation, carbon dioxide is retained but arterial blood oxygenation is maintained. This can lull the physician into a false sense of security regarding a patient’s respiratory status.

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