Weaning and extubation failure in myasthenic crisis: a multicenter analysis

Area of Science:

• Neurology
• Critical Care Medicine

Background:

• Myasthenic crisis (MC) is a severe complication of myasthenia gravis (MG) often necessitating mechanical ventilation.
• Understanding factors influencing weaning and extubation success is crucial for managing MC patients.

Purpose of the Study:

• To analyze the frequency and risk factors of weaning failure (WF) and extubation failure (EF) in MC patients.
• To assess the impact of WF and EF on the clinical course of MC.
• To compare the efficacy of different first-line treatments (IVIG vs. plasma exchange/immunoadsorption) on WF.

Main Methods:

• Retrospective chart review of MC patients requiring mechanical ventilation across 12 German neurological departments (2006-2015).
• Definition of WF: negative spontaneous breathing trial, primary tracheostomy, or extubation failure (reintubation/death).
• Statistical analysis to identify risk factors for WF and EF and their association with clinical outcomes.

Main Results:

• Weaning failure (WF) occurred in 64.2% of episodes.
• Risk factors for WF included older age, multiple comorbidities (≥3), late-onset MG, atelectasis, pneumonia, CPR, and sepsis.
• WF was more frequent with intravenous immunoglobulin (IVIG) therapy compared to plasma exchange or immunoadsorption.
• Extubation failure (EF) occurred in 43.0% of initial attempts and correlated with prolonged ventilation and hospital stay.
• Optimal extubation success was observed between days 7 and 12 post-intubation.

Conclusions:

• WF and EF are frequent in MC, associated with poor clinical outcomes.
• Older age, comorbidities, and pulmonary/cardiac complications significantly increase the risk of WF and EF.
• First-line plasma exchange/immunoadsorption may be associated with lower WF rates than first-line IVIG in MC.