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A 53-year-old man rapidly developed quadriplegia and tachypnoea (figure 1). Electrophysiologic studies showed demyelinating features consistent with Guillain-Barré syndrome. He required a tracheostomy and gastrostomy.
Paradoxical breathing, also known as thoracoabdominal asynchrony, was seen (see online video). Normally during inspiration, the abdomen and chest expand in a synchronised fashion. During inspiration a downward movement of diaphragm pushes the abdominal contents out as the ribs are lifted and moved out, causing both chest and abdomen to rise. With diaphragmatic paralysis, …
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