چكيده لاتين :
Objective
Neuromuscular disorders (diseases of the motor unit), can cause respiratory
pr oblem s suc h as impaired cough refl ex, chest deformity, recurrent
pneumonia and acute respiratory failure; these are the worst most common
complicatio ns of these di seases and the leading cause of death in such
patients (1, 2). Their management hence, very often, entails admission to
the Pediatric Intensive Care Unit (PICU) (3,4) and during thi s phase,
endotracheal intubation is almost always necessary, to maintain the patency
of airways and to apply Positive Pressure Ventilation (PPV). However,
endot racheal intubation is always temporary, and its success or failure
depends on the timely decisi on of its termination to restore th e normal
respirat ion or to avo id the risk of recurring respiratory failure (5, 6). We
designed this study to evalu ate the role of neuromuscular disorders in
causing extubation failure as compared to th at of other risk factors.
Materials & Methods
In an analytical cross-sectional study, the risk factors of reintubation and
duration of mechan ical ventil ation in two groups of 30 patients each, was
compared, the first successful extubation and the second with extubation
failure.
Results
Neuromuscular di sorders (including Spinal Muscula r Atrophy, GuillainBarreי
Syndrome, Congenital Myopathies and Muscular Dystrophi es) were
th e main underlying diseases in extubation-failure group (P= 0.0002) .
Hypercapnia (PaC02 (GREATER THAN)50mmHg) was shown to be the most common
cause of both the first intubation (P=0.001) and reintubation (P=0.004)
in the group of patients wh o failed extubatio n. The mean duration of
intubation and mechani cal ventilation was lon ger in patients with
neuromuscular di sorders who had extubation failure (P= 0.01 ).
Conclusion
This study showed that, as underlying problems, neuromuscular disorders
are the most common causes of prolon ged intubation whi ch defeat weaning
from the ventilator and result in reintubation by inducing hyp ercapnia.
Therefore the weaning process needs to be don e gradually in these patients,
and in conjunction with supportive measures, such as close observation
for at least for 72 hours foll owing extubation to monitor any possibility of
recurrence of hypercapni c respirat ory failure
