Skip to main content
SpringerLink
Log in

Noninvasive Ventilation in Myasthenic Crises

  • Chapter
Noninvasive Mechanical Ventilation

  • 3372 Accesses

Abstract

Myasthenic crisis is acute neuromuscular respiratory insufficiency requiring ventilator support in myasthenia gravis patients. Noninvasive ventilation (NIV) has fewer respiratory complications, shorter intensive care unit and hospital lengths of stay, and less respiratory support needs than invasive mechanical ventilation (IMV). There are no formal guidelines for choosing one or the other. Randomized trials comparing NIV with IMV are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

EPAP:

Expiratory positive airway pressure

ICU:

Intensive care unit

IMV:

Invasive mechanical ventilation

IPAP:

Inspiratory positive airway pressure

MC:

Myasthenic crisis

MG:

Myasthenia gravis

NIV:

Noninvasive ventilation

PaCO2 :

Partial pressure of carbon dioxide in arterial blood

RI:

Respiratory insufficiency

SpO2 :

Saturation level of oxygen in hemoglobin by arterial puncture

References

  1. Lacomis D. Myasthenic crisis. Neurocrit Care. 2005;3(3):189–94.

    Article  PubMed  Google Scholar 

  2. Bedlack RS, Sanders DB. On the concept of myasthenic crisis. J Clin Neuromusc Dis. 2002;4(1):40–2.

    Article  Google Scholar 

  3. Keesey JC. “Crisis” in myasthenia gravis: an historical perspective. Muscle Nerve. 2002;26(1):1–3.

    Article  PubMed  Google Scholar 

  4. Thomas CE, Mayer SA, Gungor Y, et al. Myasthenic crisis: clinical features, mortality, complications, and risk factors for prolonged intubation. Neurology. 1997;48(5):1253–60.

    Article  CAS  PubMed  Google Scholar 

  5. Fink ME. Treatment of the critically ill patient with myasthenia gravis. In: Ropper AH, editor. Neurological and neurosurgical intensive care. 3rd ed. New York: Raven; 1993. p. 351–62.

    Google Scholar 

  6. Mayer SA. Intensive care of the myasthenic patient. Neurology. 1997;48 Suppl 5:S70–5.

    Article  Google Scholar 

  7. Qureshi AI, Choudhry MA, Akbar MS, et al. Plasma exchange versus intravenous immunoglobulin treatment in myasthenic crisis. Neurology. 1999;52(3):629–32.

    Article  CAS  PubMed  Google Scholar 

  8. Stricker RB, Kwiatkowska BJ, Habis JA, Kiprov DD. Myasthenic crisis: response to plasmapheresis following failure of intravenous gamma-globulin. Arch Neurol. 1993;50(8):837–40.

    Article  CAS  PubMed  Google Scholar 

  9. Cohen MS, Younger D. Aspects of the natural history of myasthenia gravis: crisis and death. Ann N Y Acad Sci. 1981;377:670–7.

    Article  CAS  PubMed  Google Scholar 

  10. Varelas PN, Chua HC, Natterman J, et al. Ventilatory care in myasthenia gravis crisis: assessing the baseline adverse event rate. Crit Care Med. 2002;30(12):2663–8.

    Article  PubMed  Google Scholar 

  11. Keenan SP, Brake D. An evidence-based approach to noninvasive ventilation in acute respiratory failure. Crit Care Clin. 1998;14(3):359–72.

    Article  CAS  PubMed  Google Scholar 

  12. Simonds AK, Muntoni F, Heather S, et al. Impact of nasal ventilation on survival in hypercapnic Duchenne muscular dystrophy. Thorax. 1998;53(11):949–52.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Pinto AC, Evangelista T, Carvalho M, et al. Respiratory assistance with a non-invasive ventilator (Bipap) in MND/ALS patients: survival rates in a controlled trial. J Neurol Sci. 1995;129:S19–26.

    Article  Google Scholar 

  14. Rabinstein A, Wijdicks EF. BiPAP in acute respiratory failure due to myasthenic crisis may prevent intubation. Neurology. 2002;59(10):1647–9.

    Article  PubMed  Google Scholar 

  15. Seneviratne J, Mandrekar J, Wijdicks EFM, Rabinstein AA. Noninvasive ventilation in myasthenic crisis. Arch Neurol. 2008;65(1):54–8.

    Article  PubMed  Google Scholar 

  16. 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(1):e6.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Alshekhlee A, Miles JD, Katirji B, et al. Incidence and mortality rates of myasthenia gravis and myasthenic crisis in US hospitals. Neurology. 2009;72:1548–54.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neuromuscular Unit, Institute of Molecular Medicine, University of Lisbon, Lisbon, Portugal

    Susana Pinto

  2. Faculdade de Medicina, Translational and Clinical Physiology Unit, Institute of Molecular Medicine, Universidade de Lisboa, Lisbon, Portugal

    Mamede de Carvalho

  3. Neuroscience Department, Centro Hospitalar Lisboa Norte – Hospital de Santa Maria, Lisbon, Portugal

    Mamede de Carvalho

Authors
  1. Susana Pinto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mamede de Carvalho
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Susana Pinto .

Editor information

Editors and Affiliations

  1. Murcia, Spain

    Antonio M. Esquinas

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Pinto, S., de Carvalho, M. (2016). Noninvasive Ventilation in Myasthenic Crises. In: Esquinas, A. (eds) Noninvasive Mechanical Ventilation. Springer, Cham. https://doi.org/10.1007/978-3-319-21653-9_41

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-21653-9_41

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-21652-2

  • Online ISBN: 978-3-319-21653-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation