Acute neuromuscular respiratory failure after ICU discharge. Report of five patients

Objective: To describe a syndrome of acute neuromuscular respiratory failure (NM-ARF) caused by ICU-acquired acute myopathy and neuropathy. Design: Case series. Setting: General Regional University Hospital in Brescia, Italy. Patients: Five adult patients with NM-ARF after prolonged ICU stay and successful weaning from the ventilator and ICU discharge. Interventions: None. Measurements: Clinical signs of NM-ARF electroneurography and electromyography (ENMG) of peripheral nerves and muscles, and functional assessment of respiratory muscles. Results: NM-ARF was diagnosed at the time of (one case), or 1-3 days after, ICU discharge. Limb weakness alarmed the physicians, while the signs of the NM-ARF were initially undetected. In the first observed case the acute respiratory failure was near fatal, and necessitated ICU readmission, while in the other cases 2 weeks of aggressive chest physiotherapy permitted resolution of the respiratory failure.