Hypoventilation Syndrome in Bulbar Poliomyelitis

Because of the complex nature of respiratory inadequacy due to bulbar poliomyelitis and the severity of associated disturbances in acutely ill patients with this disease, there is little precise knowledge of the disturbed respiratory mechanism itself. In a patient whose muscles of respiration do not coordinate and whose respiratory air flow pattern is grossly irregular, it is sometimes difficult to tell whether the irregularity is caused by involvement of the respiratory center or by the airway difficulties engendered by cranial nerve involvement. Detailed attention to the maintenance of a clear airway, auscultation over the larynx, and visual observation of the character of the patient's respiratory effort often help to differentiate respiratory center involvement from the irregularity that arises as a result of the protective reflexes that are invoked to prevent the pulmonary aspiration of mucus and saliva. The gross irregularity of breathing and the ventilatory inadequacy which may be associated