Management

The management of neurological respiratory failure involves an attentive balance between monitoring and treatment:

Monitoring:

• blood gases - good until too late
• counting numbers in one breath
• vital capacity - panic value of less than 1 litre
• negative inspiratory force - not usually in the UK - panic value of less than 25cm of water

Treatment:

• ICU for observation
• frequent low vital capacity and negative inspiratory force - these should be taken in context - i.e. the rate of fall, or fall superimposed on previously poor performance.
• nil by mouth if there is a danger of aspiration
• intubate and ventilate before arrest