The Application of Noninvasive Ventilation in Patients with Myasthenic Crisis after Thymectomy_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

HeWeiqun , SangLing , LiuXiaoqing , NongLingbo ,  LiYimin

Department of Intensive Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, China;

Corresponding author：

LiYimin, Email: dryiminli@vip.163.com

Keywords：

Noninvasive ventilation; Thymectomy; Myasthenia gravis; Myasthenic crisis

DOI：

10.7507/1671-6205.2014060

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the effect of noninvasive ventilation (NIV) in patients with myasthenic crisis after thymectomy. Methods 31 myasthenic crisis patients after thymectomy who initially used NIV,admitted in the First Affiliated Hospital of Guangzhou Medical University between January 2011 and June 2013,were analyzed retrospectively.They were assigned to two groups according to the successful application of NIV or not,with 13 patients in the NIV success group and 18 patients in the NIV failure group.The related factors including gender,age,APACHEⅡ score when admitted to ICU,the results of blood gas analysis before NIV,thymoma or not,the history of myasthenic crisis,the history of chronic lung disease,and minute ventilation accounted for the largest percentage of predicted value (MVV%pred)were analyzed. Results There were no significant differences in age,gender,or APACHEⅡ score between two groups (P>0.05).The PaCO₂ in the NIV success group was lower than that in the NIV failure group.The preoperative MVV%pred in the NIV success group was higher than that in the NIV failure group.There were no significant differences between two groups in pH,PO₂,thymoma or not,the history of myasthenic crisis,or the history of chronic lung disease (P>0.05).If using the 45 mm Hg as the cut-off value of PaCO₂ and 60% as the cut-off value of MVV%pred,the incidence of PaCO₂<45 mm Hg and the incidence of MVV%pred>60% were higher in the NIV success group than those in the NIV failure group (84.6% vs.33.3%, P<0.05;100% vs. 55.6%,P<0.05).Logistic regression analysis revealed that PaCO₂<45 mm Hg was an independent influence factor for successful application of NIV in patients with myasthenic crisis after thymectomy. Conclusion PaCO₂<45 mm Hg can be a predictor of successful application of NIV in patients with myasthenic crisis after thymectomy.For the patients underwent NIV whose PaCO₂<45 mm Hg or MVV%pred<60%,the clinician should predict the possibility of failure and prepared for intubation.

Citation： HeWeiqun, SangLing, LiuXiaoqing, NongLingbo, LiYimin. The Application of Noninvasive Ventilation in Patients with Myasthenic Crisis after Thymectomy. Chinese Journal of Respiratory and Critical Care Medicine, 2014, 13(3): 250-253. doi: 10.7507/1671-6205.2014060 Copy

1.	Chaudhuri A,Behan PO.Myasthenic crisis.QJM,2009,102:97-107.
2.	Majid A,Hill NS.Noninvasive ventilation for acute respiratory failure.Curr Opin Crit Care,2005,11:77-81.
3.	Rabatin JT,Gay PC.Noninvasive ventilation.Mayo Clin Proc,1999,74:817-820.
4.	Hess DR.Noninvasive ventilation in neuromuscular disease:equipment and application.Respir Care,2006,51:896-911.
5.	Lo Coco D,Marchese S,Pesco MC,et al.Noninvasive positive-pressure ventilation in ALS:predictors of tolerance and survival.Neurology,2006,67:761-765.
6.	Agarwal R,Reddy C,Gupta D.Noninvasive ventilation in acute neuromuscular respiratory failure due to myasthenic crisis:case report and review of literature.Emerg Med J,2006,23:e6.
7.	Amato AA.Noninvasive mechanical ventilation in patients with myasthenic crisis. Nat Clin Pract Neurol,2008,4:356-357.
8.	Godoy DA,Mello LJ,Masotti L,et al.The myasthenic patient in crisis:an update of the management in Neurointensive Care Unit.Arq Neuropsiquiatr,2013,71:627-639.
9.	Rabinstein A,Wijdicks EF.BiPAP in acute respiratory failure due to myasthenic crisis may prevent intubation.Neurology,2002,59:1647-1649.
10.	Seneviratne J,Mandrekar J,Wijdicks EF,et al.Noninvasive ventilation in myasthenic crisis.Arch Neuro,2008,65:54-58.
11.	Chu X,Xue Z,Wang R,et al.Predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy.Chin Med J(Engl),2011,124:1246-1250.
12.	Heliopoulos I,Patlakas G,Vadikolias K,et al.Maximal voluntary ventilation in myasthenia gravis.Muscle Nerve,2003,27:715-719.

1. Chaudhuri A,Behan PO.Myasthenic crisis.QJM,2009,102:97-107.
2. Majid A,Hill NS.Noninvasive ventilation for acute respiratory failure.Curr Opin Crit Care,2005,11:77-81.
3. Rabatin JT,Gay PC.Noninvasive ventilation.Mayo Clin Proc,1999,74:817-820.
4. Hess DR.Noninvasive ventilation in neuromuscular disease:equipment and application.Respir Care,2006,51:896-911.
5. Lo Coco D,Marchese S,Pesco MC,et al.Noninvasive positive-pressure ventilation in ALS:predictors of tolerance and survival.Neurology,2006,67:761-765.
6. Agarwal R,Reddy C,Gupta D.Noninvasive ventilation in acute neuromuscular respiratory failure due to myasthenic crisis:case report and review of literature.Emerg Med J,2006,23:e6.
7. Amato AA.Noninvasive mechanical ventilation in patients with myasthenic crisis. Nat Clin Pract Neurol,2008,4:356-357.
8. Godoy DA,Mello LJ,Masotti L,et al.The myasthenic patient in crisis:an update of the management in Neurointensive Care Unit.Arq Neuropsiquiatr,2013,71:627-639.
9. Rabinstein A,Wijdicks EF.BiPAP in acute respiratory failure due to myasthenic crisis may prevent intubation.Neurology,2002,59:1647-1649.
10. Seneviratne J,Mandrekar J,Wijdicks EF,et al.Noninvasive ventilation in myasthenic crisis.Arch Neuro,2008,65:54-58.
11. Chu X,Xue Z,Wang R,et al.Predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy.Chin Med J(Engl),2011,124:1246-1250.
12. Heliopoulos I,Patlakas G,Vadikolias K,et al.Maximal voluntary ventilation in myasthenia gravis.Muscle Nerve,2003,27:715-719.

Chinese Journal of Respiratory and Critical Care Medicine

The Application of Noninvasive Ventilation in Patients with Myasthenic Crisis after Thymectomy

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content