Iatrogenic-induced dysfunction of the neuromuscular respiratory system.
In the presence of respiratory symptoms that are associated with alveolar hypoventilation or a restrictive ventilatory defect and in the absence of parenchymal or pleural abnormalities on the chest radiograph, iatrogenic causes must be evoked, exactly as they are in the presence of interstitial lung disease. In most cases, the anamnestic and clinical contexts provide a strong diagnostic presumption. It is important to establish carefully the mechanism of the observed disorders, using the currently available arsenal of diagnostic tools for clinical and prognostic reasons and from a medicolegal standpoint. It is necessary to evaluate precisely the clinical repercussions of the respiratory neuromuscular abnormality to serve as a basis for follow-up and to discuss therapeutic options in certain cases (eg, nocturnal ventilation to correct nocturnal hypoventilation due to diaphragmatic dysfunction, diaphragm plication to alleviate dyspnea after complete phrenic nerve destruction, phrenic nerve pacing), again in the perspective of medicolegal actions.
Similowski
Thomas
T
Service de Pneumologie, Groupe Hospitalier Pitié-Salpetrière, Assistance Publique--Hôpitaux de Paris, France. thomas.similowski@psl.ap-hop-paris.fr
Straus
Christian
C
D003964:Diaphragm / Q000503:physiopathology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007049:Iatrogenic Disease; D008171:Lung Diseases / Q000139:chemically induced* / Q000503:physiopathology; D009135:Muscular Diseases / Q000139:chemically induced; D010791:Phrenic Nerve / Q000503:physiopathology; D011650:Pulmonary Alveoli / Q000187:drug effects / Q000503:physiopathology*; D012119:Respiration / Q000187:drug effects*; D012132:Respiratory Muscles / Q000187:drug effects / Q000503:physiopathology*
D005938:Glucocorticoids