Noninvasive Ventilation in Myasthenic Crisis

Abstract

Background: Myasthenic crisis (MC) is often associated with prolonged intubation and with respiratory complications. Objectives: To assess predictors of ventilation duration and to compare the effectiveness of endotracheal intubation and mechanical ventilation (ET-MV) with bilevel positive airway pressure (BiPAP) noninvasive ventilation in MC.

Our Clinical Experience in the Treatment of Myasthenia Gravis Acute Exacerbations with a Novel Nanomembrane-Based Therapeutic Plasma Exchange Technology

“…Our primary outcomes ( Table 2 ) support the advantages of TPE for superior ventilator status in terms of less intubation with IMV, more NIV, less tracheotomy, and quick response rate in MC reported by others [ 14 , 20 , 21 , 22 , 23 , 24 , 25 ]. Our secondary outcomes ( Table 4 ) support the role of TPE for early extubation (≤7 days) as well as the role of NIV for decreasing ventilation duration (≤7 days) reported by others [ 9 , 26 ]. Our findings also suggest that older age, higher MGFA class on admission, and late-onset MG ( Table 2 , Figure 1 ) increase the risk of long-term ventilation, which is line with the findings reported by others [ 5 , 27 ].…”

Our Clinical Experience in the Treatment of Myasthenia Gravis Acute Exacerbations with a Novel Nanomembrane-Based Therapeutic Plasma Exchange Technology

“…Our primary outcomes ( Table 2 ) support the advantages of TPE for superior ventilator status in terms of less intubation with IMV, more NIV, less tracheotomy, and quick response rate in MC reported by others [ 14 , 20 , 21 , 22 , 23 , 24 , 25 ]. Our secondary outcomes ( Table 4 ) support the role of TPE for early extubation (≤7 days) as well as the role of NIV for decreasing ventilation duration (≤7 days) reported by others [ 9 , 26 ]. Our findings also suggest that older age, higher MGFA class on admission, and late-onset MG ( Table 2 , Figure 1 ) increase the risk of long-term ventilation, which is line with the findings reported by others [ 5 , 27 ].…”

The Role of Non-invasive Ventilation and Factors Predicting Extubation Outcome in Myasthenic Crisis

“…In a recent study reported by Seneviratne and Rabinstein, NIV was the initial ventilatory support in 24 episodes of myasthenic crisis and intubation was prevented in 14 episodes [17]. In that study, severe hypercapnia (PaCO 2 > 45 mmHg) was a predictor for NIV failure [17]. In our study, NIV can be safely applied to prevent intubation in myasthenic crisis if the initial serum bicarbonate concentration was below 30 mmol/l and the APACHE II score was less than six.…”

Non‐Invasive Versus Invasive Ventilation for Acute Respiratory Failure in Neuromuscular Diseases: A Systematic Scoping Review

“…Additionally, in the study by Seneviratne et al. [12], the length of ICU stay was significantly correlated with longer duration of ventilation ( p < 0.001).…”

Our Clinical Experience in the Treatment of Myasthenia Gravis Acute Exacerbations with a Novel Nanomembrane-Based Therapeutic Plasma Exchange Technology

“…Our primary outcomes ( Table 2 ) support the advantages of TPE for superior ventilator status in terms of less intubation with IMV, more NIV, less tracheotomy, and quick response rate in MC reported by others [ 14 , 20 , 21 , 22 , 23 , 24 , 25 ]. Our secondary outcomes ( Table 4 ) support the role of TPE for early extubation (≤7 days) as well as the role of NIV for decreasing ventilation duration (≤7 days) reported by others [ 9 , 26 ]. Our findings also suggest that older age, higher MGFA class on admission, and late-onset MG ( Table 2 , Figure 1 ) increase the risk of long-term ventilation, which is line with the findings reported by others [ 5 , 27 ].…”

The Role of Non-invasive Ventilation and Factors Predicting Extubation Outcome in Myasthenic Crisis

“…In a recent study reported by Seneviratne and Rabinstein, NIV was the initial ventilatory support in 24 episodes of myasthenic crisis and intubation was prevented in 14 episodes [17]. In that study, severe hypercapnia (PaCO 2 > 45 mmHg) was a predictor for NIV failure [17]. In our study, NIV can be safely applied to prevent intubation in myasthenic crisis if the initial serum bicarbonate concentration was below 30 mmol/l and the APACHE II score was less than six.…”

Non‐Invasive Versus Invasive Ventilation for Acute Respiratory Failure in Neuromuscular Diseases: A Systematic Scoping Review

“…Additionally, in the study by Seneviratne et al. [12], the length of ICU stay was significantly correlated with longer duration of ventilation ( p < 0.001).…”

Our Clinical Experience in the Treatment of Myasthenia Gravis Acute Exacerbations with a Novel Nanomembrane-Based Therapeutic Plasma Exchange Technology

“…Our primary outcomes ( Table 2 ) support the advantages of TPE for superior ventilator status in terms of less intubation with IMV, more NIV, less tracheotomy, and quick response rate in MC reported by others [ 14 , 20 , 21 , 22 , 23 , 24 , 25 ]. Our secondary outcomes ( Table 4 ) support the role of TPE for early extubation (≤7 days) as well as the role of NIV for decreasing ventilation duration (≤7 days) reported by others [ 9 , 26 ]. Our findings also suggest that older age, higher MGFA class on admission, and late-onset MG ( Table 2 , Figure 1 ) increase the risk of long-term ventilation, which is line with the findings reported by others [ 5 , 27 ].…”

The Role of Non-invasive Ventilation and Factors Predicting Extubation Outcome in Myasthenic Crisis

“…In a recent study reported by Seneviratne and Rabinstein, NIV was the initial ventilatory support in 24 episodes of myasthenic crisis and intubation was prevented in 14 episodes [17]. In that study, severe hypercapnia (PaCO 2 > 45 mmHg) was a predictor for NIV failure [17]. In our study, NIV can be safely applied to prevent intubation in myasthenic crisis if the initial serum bicarbonate concentration was below 30 mmol/l and the APACHE II score was less than six.…”

Non‐Invasive Versus Invasive Ventilation for Acute Respiratory Failure in Neuromuscular Diseases: A Systematic Scoping Review

“…Additionally, in the study by Seneviratne et al. [12], the length of ICU stay was significantly correlated with longer duration of ventilation ( p < 0.001).…”