Seneviratne et al identified risk factors associated with extubation failure and/or the need for reintubation in a patient following myasthenic crisis. These can help identify a patient who may benefit from closer monitoring and more aggressive management. The authors are from the Mayo Clinic in Rochester,


Extubation failure was defined as need for reintubation, performance of a tracheostomy during the same admission or death while intubated (the last item seems a bit odd).


Risk factors associated with extubation failure:

(1) male gender

(2) atelectasis

(3) history of previous myasthenic crisis

(4) intubation for > 10 days


Reintubation was performed for either upper airway obstruction or respiratory fatigue.


Risk factors associated with the need for reintubation:

(1) atelectasis

(2) arterial pH < 7.4 (see Table 2, page 931)

(3) lower forced vital capacity (FVC) at the time of extubation

(4) use of BiPAP (bilevel intermittent positive airway pressure) after exturbation



• The cutoff for FVC in the study group was not given. Mayer et al used an FVC > 10 mL per kg body weight as an indicator for improved muscle strength. Varelas et al used an FVC >= 15 mL per kg.


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