Rehabilitation of patients with quadriparesis after treatment of status asthmaticus with neuromuscular blocking agents and high-dose corticosteroids.

Patients with severe status asthmaticus who do not respond to intensive medical therapy are often given neuromuscular blocking agents to facilitate mechanical ventilation. Of 51 consecutive asthmatic patients treated with mechanical ventilation, 27 were treated with neuromuscular blocking agents. Of these 27 patients, all receiving high-dose intravenous steroids, four were noted to develop quadriparesis that was more severe distally. There was no cranial nerve or sensory involvement. These four patients were given physical and occupational therapy; three were transferred to the rehabilitation unit. Steady improvement in muscle strength was noted; independence in mobility and activities of daily living was achieved by the time of discharge. They were followed as outpatients until full recovery. Although the exact etiology of the complication is not known, acute steroid myopathy facilitated by the use of neuromuscular blocking agents is a likely cause. Based on the excellent recovery potential of these patients, early rehabilitation in this uncommon complication is strongly urged.