Monitoring diaphragm function in a patient with myasthenia gravis: electrical activity of the diaphragm vs. maximal inspiratory pressure

Abstract

BackgroundMaximal inspiratory pressure (MIP) is used to assess respiratory muscle strength of patients with myasthenia gravis (MG) requiring ventilatory support. Electrical activity of the diaphragm (E-di) has been used to guide weaning.Case presentationThe MIP and tidal volume/ΔE-di (the patient-to-ventilator breath contribution) were monitored in a 12-year-old girl with MG requiring ventilator support. The same ventilatory settings were maintained until extubation. During weaning, MIP increased slightly, but varied unpredictably. Tidal volume/ΔE-di decreased at a constant rate as muscle strength recovered.ConclusionIn this patient with muscle weakness, E-di was a reliable tool to monitor weaning from mechanical ventilation.

Should We Assess Diaphragmatic Function During Mechanical Ventilation Weaning in Guillain–Barré Syndrome and Myasthenia Gravis Patients?

“…Concerning Edi, a study performed in a NICU population including stroke and traumatic brain injury patients showed that an increase in Edi by 12% reflected patient exhaustion [ 23 ]. Concerning MG, a single-case report suggested its usefulness as an early marker of respiratory muscles recovery [ 24 ]. Some limitation should however be emphasized.…”