Non invasive mechanical ventilation in patients with respiratory failure of neuromuscular origin

The boundaries for the use of the non invasive ventilation [NIV] continue to expand, till now a few number of trials studied the application of NPPV in specific neuromuscular disorders [NMD] as myasthenia gravis and Guillain-Barre Syndrome, while many studies supported the use of NPPV in Duchenne muscular dystrophy. For chronic respiratory failure, a wide consensus now favors the use of NPPV as the ventilatory mode of the first choice for patients with neuromuscular diseases. It is important to predict those likely to fail with NPPV due to the expensive and intensive medical care used for these patients. The aim of this study was to evaluate the efficacy of NPPV specially in correcting gas exchange abnormalities and in avoidance of tracheal intubation in the management of respiratory failure of neuromuscular origin. This study was carried out on 13 patients with respiratory failure [6 patients with ARF, 7 patients with CRF] of neuromuscular origin. These patients fulfilled the diagnostic criteria for each specific disorder [9 with GB syndrome, 3 with MG, and one with DMD] with either acute or chronic respiratory failure. The patients were classified into 2 main groups; group I with ARF [6 patients] and group II with CRF [7 patients]. They all received NPPV using bilevel positive pressure ventilation plus standard medical treatment. All cases were subjected to thorough history taking and physical examination, chest x-ray, neuro-physiological studies, ABG, some hematological and biological indices, derived variables with regular follow up and recording of ventilator variables with detection of associated complications of NPPV. The overall success rate of NPPV was 69.2%, this was 50%for group I with ARF and 85.7%, for group II with CRF. In group I with ARF when compared with the base line values, there was a significant decrease in RR, HR, MAP, and PaO2 after one hour of the study, while the rise in SaO2, pH and the decrease in PaCO2 were significant after the 2nd hour of the study. In group II with CRF when compared with the base line values, we have observed a significant reduction in RR after the first day, while both the rise in PaO2 and the decrease in PaCO2 were significantly after the second day of the study. Also SaO2 and HR were improved only after the 7th day of the study while, on the other hand, PH and MAP were unchanged significantly till the end of the study. Application of NPPV as a safe and a routine line of therapy in patients with respiratory failure of neuromuscular origin for correction of arterial blood gas abnormalities, stabilizing vital signs, and avoiding tracheal intubations and its complications in these patients. Results of NPPV therapy in chronic respiratory failure of NM origin is much better than in acute respiratory failure of NM origin. Use of NPPV in ARF due to Guillain-Barre Syndrome with a great precaution especially with those having severe bulbar palsy for fear of aspiration events

study of diabetic and non-diabetic neuropathies in diabtic patients: the magnitude of the problem

The epidemiology of diabetic and non-diabetic neuropathies in diabetic patients is important for agreement over its diagnostics criteria. The present study aimed to put the diagnostic criteria for both neuropathies in diabetic patients. The study comprised 60 diabetic patients with symptomatic neuropathy [40 males and 20 females] with age ranged from 21 to 82 year. They were subdivided into 2 subgroups, according to type of their diabetes, group 1 [45 patients with II DM] group 2 [15 patients with type I DM]. They were evaluated in order to know more about the cause of neuropathy in this population and the signs and symptoms that could suggest other cause than diabetes in this sitting. Diabetes accounted for [75%] of the neuropathies in the whole group of patients while twenty-five percent [25%] of patients have a neuropathy unrelated to diabetes. Chronic inflammatory demyelinating neuropathy that was diagnosed in 10%is the most common non-diabetic cause of neuropathy within population. A short interval between diagnosis of diabetes and the onset of the neuropathy, early motor deficit, markedly asymmetrical deficit and generalized areflexia, which are all uncommon in the diabetic neuropathy, in favor of a non-diabetic origin of the neuropathy and should lead to further investigations