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    Neuromuscular and Other Diseases of The Chest Wall

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    lucky
    1) Neuromuscular diseases affect the function of muscles through problems with nerves or muscles themselves. 2) This can lead to respiratory failure through issues like weakness of breathing muscles or impaired control of breathing. 3) Management includes techniques like breathing exercises and non-invasive ventilation to improve ventilation and prevent respiratory failure.

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    Neuromuscular and Other Diseases of The Chest Wall

    Uploaded by

    lucky
    56 views25 pages
    1) Neuromuscular diseases affect the function of muscles through problems with nerves or muscles themselves. 2) This can lead to respiratory failure through issues like weakness of breathing muscles or impaired control of breathing. 3) Management includes techniques like breathing exercises and non-invasive ventilation to improve ventilation and prevent respiratory failure.

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    Neuromuscular-and-Other-Diseases-of-the-Chest-Wall

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    1) Neuromuscular diseases affect the function of muscles through problems with nerves or muscles themselves. 2) This can lead to respiratory failure through issues like weakness of breathing muscles or impaired control of breathing. 3) Management includes techniques like breathing exercises and non-invasive ventilation to improve ventilation and prevent respiratory failure.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    56 views25 pages

    Neuromuscular and Other Diseases of The Chest Wall

    Uploaded by

    lucky
    1) Neuromuscular diseases affect the function of muscles through problems with nerves or muscles themselves. 2) This can lead to respiratory failure through issues like weakness of breathing muscles or impaired control of breathing. 3) Management includes techniques like breathing exercises and non-invasive ventilation to improve ventilation and prevent respiratory failure.

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    Neuromuscular and Other

    Diseases of the Chest Wall

     Pathophysiology and PFT


     Clinical Signs and Symptoms
    What is neuromuscular weakness?
    • Neuromuscular diseases affects the function
    of muscles in your body. These conditions are
    usually due to problems with the nerves not
    sending information to your muscles and/or
    the muscles not working correctly.
    Neuromuscular Diseases Causing
    Respiratory Failure
    • Cerebral Cortex
    – Stroke, tumor, traumatic brain injury
    • Brainstem
    – Drugs, hemorrhage, anoxia, polio, multiple sclerosis
    • Spinal Cord
    – Trauma, tumor, tetanus, myelitis
    • Motor Nerves
    – ALS, GBS
    • Neuromuscular Junction
    – Drugs, MG, neurotoxins
    • Myopathies
    – Duchenne’s muscular dystrophy, acid maltase deficiency, pompe disease,
    myotonic dystrophy
    Chest Wall Diseases
    • Scoliosis
    • Kyphosis
    • Poland Syndrome
    • Pectus Excavatum
    • Pectus Carinatum
    • Tumors in the chest wall
    • Flail chest
    What kind of sleep problems should I look
    for if I have a neuromuscular condition?
    • 3 problems that can affect breathing with
    neuromuscular weakness while sleeping are:
    – Nocturnal hypoventilation
    – Obstructive sleep apnea
    – Central sleep apnea
    • A patient can have any or all of these
    problems depending on the type of
    neuromuscular disease he has.
    Chest Wall Malformations
    Pectus Excavatum Pectus Carinatum
    Cobb angle is an orthopedic measurement used
    in vertebral bending disorders. 10 degrees of
    deviation from straight before scoliosis is defined.
    20 degrees will require back braces while 40
    degrees requires surgery

    Flail Chest Scoliosis


    Kyphosis Poland Syndrome
    Pulmonary Consequences of Neuromuscular
    Disease
    • Hyperventilation (initial sign)
    • Central apnea
    • Lung hypoventilation
    • Pulmonary hypertension
    Maintenance of Normal Ventilation

    1) Regulation of Respiratory Drive


    2) Control of Ventilation
    3) Cough and other airway reflexes
    Consequences of Neuromuscular Disease

    1) Dysregulation of respiratory drive or rate


    (inability to ventilate)
    2) Loss of strength or control of the mechanics
    of breathing (aspiration risk)
    3) Loss of strength or control of the muscles
    responsible for airway protection and cough
    (inability to protect airways from the
    pathogens, irritants and foreign aspiration)
    Lung Volumes and Capacities
    1) Tidal Volume
    – Volume of air inhaled and exhaled in a quiet breathing
    – Normal: 6-8ml/kg
    – It falls when there is a restriction/obstruction.
    2) Inspiratory Reserve Volume
    – Maximum volume of air which can be inspired after a normal tidal inspiration
    from end inspiration.
    3) Expiratory Reserve Volume
    – Maximum volume of air which can be expired after a normal tidal expiration
    from end expiration.
    4) Inspiratory Capacity
    – Maximum volume of air which can be inspired after a normal tidal expiration.
    5) Expiratory Reserve Volume
    – Volume of gas that can be exhaled form end inspiratory
    level during tidal breathing
    6) Residual Volume
    – Amount of air remaining in the lungs after forceful
    expiration
    7) Fractional Residual Capacity
    – Amount of air remains in the lungs after a quiet
    respiration
    8) Vital Capacity
    – Maximum volume expired after a maximum inspiration
    Lung Volumes and Capacities
    Inspiratory Reserve
    Volume (3100ml) Inspiratory
    Capacity (3600ml) Vital Capacity
    (4800ml)
    Total Lung Capacity
    (6000ml)
    Tidal Volume
    (500ml)

    Expiratory Reserve
    Volume (1200ml) Fractional Residual
    Capacity (2400ml)

    Residual Volume Residual Volume


    (1200ml) (1200ml)
    PFT Parameters
    • Height
    • Weight
    • Age
    • Gender
    • Race
    • Pack Years (if smoker)
    Risks For PFT
    • Dizziness during the test
    • Feeling short of breath
    • Coughing
    • Asthma attack brought by deep inhalation
    • Barotrauma
    Contraindications
    • Recent belly or chest surgery
    • Chest pain, recent heart attack, or an unstable
    heart condition
    • Aneurysm
    • Active PTB or respiratory infections
    • Mechanically ventilated patients
    • Unconscious
    • Barotrauma or lung injuries
    Sample Results
    The PFT Machines
    Spirometry Plethysmography
    • Is a device with a • You sit or stand inside an
    mouthpiece hooked up to a air-tight box that looks like a
    small electronic machine. short, square telephone
    • Can only measure: FVC, booth to do the tests.
    Peak expiratory flow rate • Can measure up to TLC
    PFT Result Expectancy of a Neuromuscular
    Weakness
    PFT of Patients With Neuromuscular Disease

    • Normal lungs revealing restrictive result as


    muscles became weak and won’t facilitate
    thoracic expansion. (Decreased VC, FEV1, TLC)
    • Residual volume stays the same as normal.
    • Position changes directly affects thoracic
    expansion. (seated to supine >20% decline in
    FEV1 and vital capacity)
    Pathophysiology
    Impaired CNS Function

    Loss of Respiratory Muscle Strength

    Decreased Vital Capacity

    Slow Shallow Breathing


    Severe
    Hypercapnia,
    Hypoxemia
    V/Q Mismatch

    Acute Respiratory Failure Type 2 Decrease LOC,


    Comatose, Death

    Impaired Cellular Metabolism


    Typical Clinical Signs and Symptoms of
    Neuromuscular Disease
    • Early Stage
    – Dyspnea
    – Easy fatigability
    • Intermediate Stage
    – Orthopnea
    – Pulmonary hypertension
    – Anorexia
    – Chest pain/tightness
    – Syncope
    • Late Stage
    – Cor pulmonale (right sided heart failure)
    – CHF (left and right sided heart failure)
    – Pulmonary congestion and systemic congestion
    – Multiple organ dysfunction syndrome
    Monitoring and Assessment
    • Respiratory muscle weakness leads to fatigue
    and respiratory failure. (must initiate positive
    pressure ventilation or mechanical ventilation
    to avoid rapid deterioration)
    • Frequent monitoring of oxygenation status,
    vital signs and level of consciousness. (ABG,
    pulse oximetry, Nero vital signs and bp, temp,
    pulse/cardiac monitoring)
    Management
    • Bronchial hygiene therapy (PD, PV, coughing
    techniques)
    • Breathing Exercises
    • Non-invasive ventilation (CPAP, BIPAP)
    • Mechanical Ventilation (worse scenario)
    • Soft diets/NGT feedings (to reduce the risk of
    aspiration)

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