Use of botulinum toxin type A to avoid tracheal intubation or tracheostomy in severe paradoxical vocal cord movement

I Maillard; V Schweizer; A Broccard; A Duscher; L Liaudet; M D Schaller

doi:10.1378/chest.118.3.874

Use of botulinum toxin type A to avoid tracheal intubation or tracheostomy in severe paradoxical vocal cord movement

Chest. 2000 Sep;118(3):874-7. doi: 10.1378/chest.118.3.874.

Authors

I Maillard¹, V Schweizer, A Broccard, A Duscher, L Liaudet, M D Schaller

Affiliation

¹ Critical Care Division, Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

PMID: 10988221
DOI: 10.1378/chest.118.3.874

Abstract

Paradoxical vocal cord movement (PVCM) is characterized by paradoxical adduction of the vocal cords during inspiration and/or expiration. Patients with severe forms of PVCM can present with acute dyspnea. In this article, we describe a patient with severe PVCM who had required tracheal intubation or tracheostomy at multiple occasions and who presented with acute hypercapnic respiratory failure. Using sedation and intralaryngeal injection of botulinum toxin type A, we could avoid more invasive intervention. Our observation shows that botulinum toxin type A should be considered in the acute care setting for severe PVCM.

Publication types

Case Reports

MeSH terms

Adult
Botulinum Toxins, Type A / administration & dosage
Botulinum Toxins, Type A / therapeutic use*
Contraindications
Female
Humans
Intubation, Intratracheal*
Laryngeal Diseases / complications
Laryngeal Diseases / drug therapy*
Laryngeal Diseases / physiopathology
Neuromuscular Agents / administration & dosage
Neuromuscular Agents / therapeutic use*
Respiratory Distress Syndrome / drug therapy*
Respiratory Distress Syndrome / etiology
Respiratory Distress Syndrome / physiopathology
Tracheostomy*
Vocal Cords / drug effects
Vocal Cords / physiopathology*

Substances

Neuromuscular Agents
Botulinum Toxins, Type A