Saturday January 6, 2007
Paradoxical abdominal movement - often ignored sign


Scenarios;

1. You have a patient who look "ok" for extubation from parameters and vitals but you noticed paradoxical abdominal movement (movement of the abdominal contents inward during inspiration). Will you extubate the patient?

2. You have a patient with Guillain-Barre syndrome who relatively look "ok" and you are in grey zone to intubate or wait as patient will soon get his third dose of plasmapheresis. You noticed paradoxical abdominal movement. Will you intubate the patient?


Answers: 1) No and 2) Yes

Many times when clinically patients appear in grey zone either for intubation or extubation, sign of paradoxical abdominal movement helps. Paradoxical abdominal movement is an important physical sign of diaphragmatic and other muscular weakness. Patient may have generalised neurological illnesses affecting muscle, neurmuscular transmission ( myasthenia gravis) or inflammatory polyneuropathies (Guillain-Barré syndrome).

In such situations early intubation for impending respiratory failure or holding extubation to rule out critical illness polyneuropathy or myopathy is appropriate.