title: Bilateral Diaphragmatic Paralysis in a Patient With Critical Illness Polyneuropathy: A Case Report.
abstract: Bilateral diaphragmatic paralysis (BDP) manifests as respiratory muscle weakness, and its association with critical illness polyneuropathy (CIP) was rarely reported. Here, we present a patient with BDP related to CIP, who successfully avoided tracheostomy after diagnosis and management.A 71-year-old male presented with acute respiratory failure after sepsis adequately treated. Repeated intubation occurred because of carbon dioxide retention after each extubation. After eliminating possible factors, septic shock-induced respiratory muscle weakness was suspected. Physical examination, a nerve conduction study, and chest ultrasound confirmed our impression.Pulmonary rehabilitation and reconditioning exercises were arranged, and the patient was discharged with a diagnosis of BDP.The diagnosis of BDP is usually delayed, and there are only sporadic reports on its association with polyneuropathy, especially in patients with preserved limb muscle function. Therefore, when physicians encounter patients that are difficult to wean from mechanical ventilation, CIP associated with BDP should be considered in the differential diagnosis.
authors.affiliation: From the Department of Physical Medicine and Rehabilitation (H-YC), Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine (M-YL), Department of Physical Medicine and Rehabilitation, Chang Gung University College of Medicine; and Division of Pulmonary and Critical Care Medicine (H-CC, M-CL), Chang Gung Memorial Hospital-Kaohsiung Medical Center, Department of Internal Medicine, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Hsuan-Yu
authors.initials: HY
authors.lastname: Chen
authors.forename: Hung-Chen
authors.initials: HC
authors.lastname: Chen
authors.forename: Meng-Chih
authors.initials: MC
authors.lastname: Lin
authors.forename: Mei-Yun
authors.initials: MY
authors.lastname: Liaw
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D011115:Polyneuropathies / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D012133:Respiratory Paralysis / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy