Multiple organ-system complications involving the cardiovascular, gastrointestinal, and neurological systems may occur subsequent to pulmonary failure. At times the initial diagnostic and therapeutic problems may be dominated by manifestations of the secondary disorder rather than of the underlying respiratory failure. Congestive heart failure and ventricular arrhythmias may necessitate cardiac monitoring, defibrillation, and resuscitation.
The involvement of another major system is underscored in a communication in the June issue of the Archives of Internal Medicine.1 First described in 1933,2 the generalized neurological signs, which mimic cerebral lesions in patients with respiratory failure, are emphasized again. The authors note that papilledema and other neurologic abnormalities do not necessarily indicate a poor prognosis if therapy for the respiratory failure is prompt.3 In addition three patients with respiratory failure and focal neurological signs are described. The focal signs include paresthesia, paresis of one extremity, unilateral Babinski reflex, unequal pupil size and