J Korean Geriatr Soc.  2012 Sep;16(3):162-166.

Amyotrophic Lateral Sclerosis Identified by Failure to Wean From Mechanical Ventilation

• Park JH
• Kim BS
• Byun YJ
• Jeong HR
• Kim SH
• Kim TH
• Sohn JW
• Shin DH
• Park SS
• Yoon HJ
• Kwak HJ

Abstract

In most cases of amyotrophic lateral sclerosis (ALS), respiratory muscle involvement is a late complication. Only 2.7% of ALS patients presenting with their first clinical symptoms in the extremities also experience respiratory symptoms. We report a case of an 81-year-old man with ALS, diagnosed by an unexplained failure to wean from mechanical ventilation. The patient was presented with acute respiratory failure, tachypnea and respiratory acidosis. Computed tomography of the chest showed large amounts of sputum in the trachea. An endotracheal tube was inserted, and the patient was placed on volume-controlled ventilation. However, in the course of recovery, he could not be weaned from mechanical ventilation, despite the absence of cardiopulmonary impairment. Having considered other causes of respiratory failure, wediagnosed ALS after a physical and neurologic examination and electrodiagnostic testing.

Keyword

Amyotrophic lateral sclerosis; Lou Gehrig's disease; Respiratory failure; Weaning failure

MeSH Terms

Acidosis, Respiratory
Aged, 80 and over
Amyotrophic Lateral Sclerosis
Extremities
Humans
Neurologic Examination
Respiration, Artificial
Respiratory Insufficiency
Respiratory Muscles
Sputum
Tachypnea
Thorax
Trachea
Ventilation