This article reviews the recognition, diagnosis and management of respiratory failure in acute neuromuscular disease. Respiratory failure requiring artificial ventilation occurs in about 14% of patients with Guillain-Barre syndrome (GBS),'a small percentage of patients with myasthenia gravis and polymyositis, and also in acute rhabdomyolysis and a wide range of other less common disorders (tables 1-3). Neuromuscular disorders are responsible for only a tiny proportion of admissions to most intensive care units, 23 (1 1%) of 2097 consecutive admissions to our own unit in the last two years. Of those cases, 15 (60%) required mechanical ventilation and two (8 7) died in hospital. The APACHE III study in North America2 documented neuromuscular disease as the cause of intensive care unit admission in only 45 patients (026%) of the cohort of 17 440 patients with a 15-6% unadjusted hospital mortality rate. These figures exclude those patients who were admitted to theintensive care unit because of operation or systemic disease and then developed neuromuscular disease which caused respiratory failure or delayed weaning off the ventilator. Respiratory failure occur-ring in the setting of chronic progressive neu-romuscular disease, such as, Duchenne muscular dystrophy and motor neuron dis-ease, presents a challenging management problem which is outside the scope of this review.