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Neurogenic paradoxical breathing
  1. Eelco F M Wijdicks
  1. Correspondence to Professor Dr Eelco F M Wijdicks, Division of Critical Care Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; wijde{at}

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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.

Figure 1

Patient with acute respiratory failure. Note anxious facial expression and associated with increased work of breathing and fatigue. The hand touches the sternocleidomastoid muscle to assess for contraction.

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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