[Respiratory insufficiency in patients with myasthenia gravis]

We evaluated 20 patients who required prolonged mechanical ventilation for respiratory failure associated with myasthenia gravis. All 20 patients survived and were weaned from the ventilator after 3 to 14 days (mean 6.5 days) of respiratory support. Progressing bulbar symptoms and respiratory infection were the most frequent causes of the myasthenic crisis. During a period of assisted mechanical ventilation, anticholinesterase medication was interrupted and the patients were treated with steroids and antibiotics. Plasmapheresis may be considered in the management of myasthenic crisis.