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(Chest. 2000;118:874-877.)
© 2000 American College of Chest Physicians

Use of Botulinum Toxin Type A to Avoid Tracheal Intubation or Tracheostomy in Severe Paradoxical Vocal Cord Movement*

Ivan Maillard, MD, PhD; Valérie Schweizer, MD; Alain Broccard, MD; Alexandre Duscher, MD; Lucas Liaudet, MD and Marie-Denise Schaller, MD

* From Critical Care Division, Department of Internal Medicine (Drs. Maillard, Broccard, Liaudet, and Schaller) and Department of Otorhinolaryngology (Drs. Schweizer and Duscher), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Correspondence to: Marie-Denise Schaller, MD, Critical Care Division, Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland; e-mail: marie-denise.schaller{at}chuv.hospvd.ch

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.

Key Words: botulinum toxin type A • dyspnea • laryngospasm • vocal cords




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