The clinical management of neuromuscular disorders in intensive care

•Close cooperation between neurointensivists and neuromuscular experts is essential.•Understanding priorities of ICU management and specific risks encountered in the ICU is crucial.•Appropriate monitoring requires thorough understanding of neuromuscular respiratory mechanics.•In both GBS and myasthenic crisis quality of step-down care significantly affects mortality.•Advanced organ support in a chronic disease aims to restore the patient's previous level of function. Life-threatening neuromuscular disorders affect a small, but growing group of patients in the intensive care unit who present special management problems, as well as great therapeutic opportunities. In inflammatory conditions, a cure is often possible, and for chronic, genetic or degenerative conditions, achieving the previous level of function is the target. Neuromuscular experts and intensivists need to cooperate closely to achieve the best possible outcomes. They need to acquire a very specific set of skills, including both a thorough understanding of the mechanics of ventilation as well as familiarity with the diagnostic categories of genetic and of autoimmune diseases. This review of the clinical management of adult neuromuscular disease in the ICU aims to provide an overview of the most important conditions encountered in the ICU and a practical approach to their diagnosis, monitoring, and treatment.