title: Use of botulinum toxin type A to avoid tracheal intubation or tracheostomy in severe paradoxical vocal cord movement.
abstract: Paradoxical vocal cord movement (PVCM) is characterized by paradoxical adduction of the vocal cords during inspiration and/or expiration. Patients with severe forms of PVCM can present with acute dyspnea. In this article, we describe a patient with severe PVCM who had required tracheal intubation or tracheostomy at multiple occasions and who presented with acute hypercapnic respiratory failure. Using sedation and intralaryngeal injection of botulinum toxin type A, we could avoid more invasive intervention. Our observation shows that botulinum toxin type A should be considered in the acute care setting for severe PVCM.
authors.affiliation: Critical Care Division, Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: I
authors.initials: I
authors.lastname: Maillard
authors.forename: V
authors.initials: V
authors.lastname: Schweizer
authors.forename: A
authors.initials: A
authors.lastname: Broccard
authors.forename: A
authors.initials: A
authors.lastname: Duscher
authors.forename: L
authors.initials: L
authors.lastname: Liaudet
authors.forename: M D
authors.initials: MD
authors.lastname: Schaller
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D000075202:Contraindications; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007818:Laryngeal Diseases / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D014139:Tracheostomy; D014827:Vocal Cords / Q000187:drug effects / Q000503:physiopathology*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A