Bilateral diaphragmatic paralysis

Ventilatory failure developed insidiously in a patient due to bilateral diaphragmatic paralysis from bilateral phrenic neuropathy. The ventilatory failure progressed to respiratory arrest. We assessed the patient's diaphragmatic function by fluoroscopy, transdiaphragmatic pressure measurements during maximal inspiration, measurement of abdominal paradoxic motion, and electrical conduction measurements of the phrenic nerves. He improved and was discharged. A rocking bed was recommended for sleep after appropriate measurements of various respiratory support apparatuses. A history of supine breathlessness and a clinical observation of paradoxic abdominal wall motion during breathing in the supine position should suggest this possible cause.