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Noninvasive ventilation in myasthenic crisis
Janaka Seneviratne1, Jay Mandrekar, Eelco F M Wijdicks
1Department of Neurology, Mayo Clinic, 200 First St SW, Mayo W8, Rochester, MN 55905, USA.
Archives of Neurology
|January 16, 2008
Summary
Bilevel positive airway pressure (BiPAP) effectively treats respiratory failure in myasthenia crisis (MC). Early BiPAP use can prevent intubation and reduce ventilation duration, shortening hospital stays.
Area of Science:
- Neurology
- Pulmonology
- Critical Care Medicine
Background:
- Myasthenic crisis (MC) frequently leads to prolonged mechanical ventilation and respiratory complications.
- Identifying predictors of ventilation duration is crucial for optimizing patient outcomes.
Purpose of the Study:
- To determine factors influencing the duration of mechanical ventilation in MC patients.
- To compare the efficacy of bilevel positive airway pressure (BiPAP) noninvasive ventilation versus endotracheal intubation and mechanical ventilation (ET-MV) in managing MC.
Main Methods:
- A retrospective cohort study was conducted, analyzing 60 MC episodes in 52 patients at the Mayo Clinic.
- Data collected included patient demographics, treatments, medical complications, ventilation duration, hospital length of stay, and respiratory function parameters.
Main Results:
- BiPAP was the initial ventilatory support in 24 episodes, while ET-MV was used in 36 episodes.
- Intubation was avoided in 14 episodes treated with BiPAP, with a mean duration of 4.3 days.
- Higher Pco(2) levels (>45 mm Hg) at BiPAP initiation predicted failure. Initial BiPAP treatment was associated with decreased ventilation duration.
Conclusions:
- Bilevel positive airway pressure (BiPAP) is an effective treatment for acute respiratory failure in myasthenia gravis.
- Initiating BiPAP before hypercapnia develops can prevent intubation, reduce ventilation duration, and decrease pulmonary complications and hospital lengths of stay.
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