Risk Factors for Prolonged Mechanical Ventilation in Post-thymectomy Myasthenic Crisis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIKun-kun ,  TANQun-you , GUOWei , MAZheng , WANGRu-wen

Department of Toracic Surgery, Institute of Surgery Research, Daping Hospital, Tird Military Medical University, Chongqing 400042, P. R. China;

Corresponding author：

TANQun-you, Email: tanfriends@163.com

Keywords：

Myasthenia gravis; Extended thymectomy; Myasthenic crisis; Pneumonia; Mechanical ventilation

DOI：

10.7507/1007-4848.20150121

Video：

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Objective To analyze the risk factors for post-thymectomy myasthenic crisis (PTMC) and prolonged mechanical ventilation, in myasthenia gravis patients who underwent extended thymectomy. Methods We retrospectively analyzed the clinical data of 79 patients including 38 males and 41 females who experienced PTMC and required mechanical ventilation in Daping Hospital between June 2008 and November 2014. Single factor analysis and multivariate analysis were conducted. Results Morbidity of PTMC was 20.6% (79/384). Result of single-factor analysis showed that postoperative pneumonia was one of the main reasons of prolonged mechanical ventilation (P < 0.05). Result of multiple-factor analysis showed that the operation time was positively correlated with mechanical ventilation time (P < 0.05). The risk factor of prolonged mechanical ventilation time in PTMC was not associated with sex, age, disease history, myasthenic crisis history, Osserman classification, dosage of pyridostigmine before and after the operation, surgical approach, bleeding volume, other therapies besides mechanical ventilation (P > 0.05). Conclusion Mechanical ventilation is one the main therapy of PTMC, operation time, and postoperative pneumonia are the main factors to prolong mechanical ventilation time. In order to decrease morbidity of PTMC and shorten mechanical ventilation time, the operation time should be controlled and pulmonary infection should be avoided.

Citation： LIKun-kun, TANQun-you, GUOWei, MAZheng, WANGRu-wen. Risk Factors for Prolonged Mechanical Ventilation in Post-thymectomy Myasthenic Crisis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(5): 463-466. doi: 10.7507/1007-4848.20150121 Copy

1.	Gronseth GS, Barohn RJ. Practice parameter:thymectomy for autoimmune myasthenia gravis (an evidence-based review):report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 2000, 55(1):7-15.
2.	Skeie GO, Apostolski S, Evoli A, et al. Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol, [2010], 17(7):893-902.
3.	Bedlack RS1, Sanders DB. On the concept of myasthenic crisis. J Clin Neuromuscul Dis, 2002, 4(1):40-42.
4.	Lacomis D. Myasthenic crisis. Neurocrit Care, 2005, 3(3):189-194.
5.	张忱, 李蜀渝, 肖波, 等.重症肌无力危象74例临床分析.内科危急重症杂志, 2010, 16(2):94-95.
6.	Soleimani A, Moayyeri A, Akhondzadeh S, et al. Frequency of myasthenic crisis in relation to thymectomy in generalized myasthenia gravis:a 17-year experience. BMC Neurol, 2004, 4:12.
7.	蒋雷.胸腺切除术治疗非胸腺瘤重症肌无力的研究进展.中国胸心血管外科临床杂志, 2013, 20(4):463-466.
8.	Spillane J, Hayward M, Hirsch NP, et al. Tymectomy:role in the treatment of my asthenia gravis. J Neurol, 2013, 260(7):1798-1801.
9.	Wu JY, Kuo PH, Fan PC, et al. Te role of non-invasive ventilation and factors predicting extubation outcome in myasthenic crisis. Neurocrit Care, 2009, 10(1):35-42.
10.	Juel VC. Myasthenia gravis:management of myasthenic crisis and perioperative care. Semin Neurol, 2004, 24(1):75-81.
11.	Chu XY, Xue ZQ, Wang RW, et al. Predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy. Chin Med J (Engl), 2011, 124(8):1246-1250.
12.	Werneck LC, Scola RH, Germiniani FM, et al. Myasthenic crisis:report of 24 cases. Arq Neuropsiquiatr, 2002, 60(3-A):519-526.
13.	Seneviratne J, Mandrekar J, Wijdicks EF, et al. Predictors of extubation failure in myasthenic crisis. Arch Neurol, 2008, 65(7):929-933.
14.	Kalita J, Kohat AK, Misra UK. Predictors of outcome of myasthenic crisis.Neurol Sci, 2014, 35(7):1109-1114.
15.	Nam TS, Lee SH, Kim BC, et al. Clinical characteristics and predictive factors of myasthenic crisis afer thymectomy. J Clin Neurosci, 2011, 18(9):1185-1188.
16.	陈佶, 庞烈文, 陈志明, 等.重症肌无力患者胸腺切除术后危象发生的多因素分析.中国临床神经科学, 2007, 15(2):169-173.
17.	Deng B, Ma Z, Jiang YG, et al. Continuous tracheal intubation in patients with myasthenia gravis after thymectomy to prevent tracheal incision for myasthenic crisis. J Torac Cardiovasc Surg, 2011, 142(1):240.
18.	石世华, 刘娜, 陈秀, 等.重症肌无力危象期持续状态成功脱离呼吸机一例.中国胸心血管外科临床杂志, 2011, 18(1):15.
19.	Kumar R, Birinder SP, Gupta S, et al. Terapeutic plasma exchange in the treatment of myasthenia gravis. Indian J Crit Care Med, 2015, 19(1):9-13.
20.	Alabdali M, Barnett C, Katzberg H, et al. Intravenous immunoglobulin as treatment for myasthenia gravis:current evidence and outcomes. Expert Rev Clin Immunol, 2014, 10(12):1659-1665.

1. Gronseth GS, Barohn RJ. Practice parameter:thymectomy for autoimmune myasthenia gravis (an evidence-based review):report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 2000, 55(1):7-15.
2. Skeie GO, Apostolski S, Evoli A, et al. Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol, [2010], 17(7):893-902.
3. Bedlack RS1, Sanders DB. On the concept of myasthenic crisis. J Clin Neuromuscul Dis, 2002, 4(1):40-42.
4. Lacomis D. Myasthenic crisis. Neurocrit Care, 2005, 3(3):189-194.
5. 张忱, 李蜀渝, 肖波, 等.重症肌无力危象74例临床分析.内科危急重症杂志, 2010, 16(2):94-95.
6. Soleimani A, Moayyeri A, Akhondzadeh S, et al. Frequency of myasthenic crisis in relation to thymectomy in generalized myasthenia gravis:a 17-year experience. BMC Neurol, 2004, 4:12.
7. 蒋雷.胸腺切除术治疗非胸腺瘤重症肌无力的研究进展.中国胸心血管外科临床杂志, 2013, 20(4):463-466.
8. Spillane J, Hayward M, Hirsch NP, et al. Tymectomy:role in the treatment of my asthenia gravis. J Neurol, 2013, 260(7):1798-1801.
9. Wu JY, Kuo PH, Fan PC, et al. Te role of non-invasive ventilation and factors predicting extubation outcome in myasthenic crisis. Neurocrit Care, 2009, 10(1):35-42.
10. Juel VC. Myasthenia gravis:management of myasthenic crisis and perioperative care. Semin Neurol, 2004, 24(1):75-81.
11. Chu XY, Xue ZQ, Wang RW, et al. Predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy. Chin Med J (Engl), 2011, 124(8):1246-1250.
12. Werneck LC, Scola RH, Germiniani FM, et al. Myasthenic crisis:report of 24 cases. Arq Neuropsiquiatr, 2002, 60(3-A):519-526.
13. Seneviratne J, Mandrekar J, Wijdicks EF, et al. Predictors of extubation failure in myasthenic crisis. Arch Neurol, 2008, 65(7):929-933.
14. Kalita J, Kohat AK, Misra UK. Predictors of outcome of myasthenic crisis.Neurol Sci, 2014, 35(7):1109-1114.
15. Nam TS, Lee SH, Kim BC, et al. Clinical characteristics and predictive factors of myasthenic crisis afer thymectomy. J Clin Neurosci, 2011, 18(9):1185-1188.
16. 陈佶, 庞烈文, 陈志明, 等.重症肌无力患者胸腺切除术后危象发生的多因素分析.中国临床神经科学, 2007, 15(2):169-173.
17. Deng B, Ma Z, Jiang YG, et al. Continuous tracheal intubation in patients with myasthenia gravis after thymectomy to prevent tracheal incision for myasthenic crisis. J Torac Cardiovasc Surg, 2011, 142(1):240.
18. 石世华, 刘娜, 陈秀, 等.重症肌无力危象期持续状态成功脱离呼吸机一例.中国胸心血管外科临床杂志, 2011, 18(1):15.
19. Kumar R, Birinder SP, Gupta S, et al. Terapeutic plasma exchange in the treatment of myasthenia gravis. Indian J Crit Care Med, 2015, 19(1):9-13.
20. Alabdali M, Barnett C, Katzberg H, et al. Intravenous immunoglobulin as treatment for myasthenia gravis:current evidence and outcomes. Expert Rev Clin Immunol, 2014, 10(12):1659-1665.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk Factors for Prolonged Mechanical Ventilation in Post-thymectomy Myasthenic Crisis

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