Medical

Neuromuscular weakness / impending respiratory failure

Before / During / After / Pitfalls

Before

• Trend work of breathing, bulbar symptoms, secretion burden, cough strength, NIF/FVC where available.
• Avoid waiting for hypoxemia; ventilatory failure may occur with normal SpO₂ until late.
• Call ICU/neurology/RT early; plan post-intubation sedation and ventilator support.

During

• Preoxygenate, but recognize the problem is ventilation/muscle fatigue rather than oxygenation alone.
• Use airway adjuncts and suction for secretion burden.
• Choose medications with neuromuscular disease considerations and local protocol guidance.

After

• Ventilator support, secretion clearance, aspiration prevention, and disease-specific therapy.
• Reassess sedation, weakness, and extubation readiness carefully.
• Communicate baseline respiratory mechanics and trajectory.

Pitfalls

• Waiting for SpO₂ to fall before acting.
• Underestimating bulbar dysfunction/aspiration risk.
• No plan for prolonged ventilatory failure.