Rabinstein and Mueller-Kronast reporte factors which can help to identify a patient with myasthenic crisis who may fail extubation. Extubation failure is associated with prolonged stays in the ICU and a worse functional outcome. The authors are from the University of Miami.


Myasthenic crisis was defined as neuromuscular respiratory failure requiring mechanical ventilation.


Patients were treated by immunomodulation using plasmapheresis and intravenous immunoglobulin.


Extubation failure was defined as the need to perform a tracheostomy and/or reintubation.


Risk factors for extubation failure:

(1) older age (mean age 60 vs 33 in patients with successful extubation, but with considerable overlap)

(2) presence of atelectasis during mechanical ventilation

(3) development of pneumonia

(4) failure to use a weaning protocol specifically developed for a patient with myasthenia


Elements of a weaning protocol for a patient with myasthenia may include:

(1) carefully timing extubation

(2) use of BiPAP after extubation

(3) intensive respiratory therapy


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