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Struggling to Get a Patient with Myasthenia Gravis off the Ventilator 

Struggling to Get a Patient with Myasthenia Gravis off the Ventilator
Chapter:
Struggling to Get a Patient with Myasthenia Gravis off the Ventilator
Source:
Neurocritical Care (2 ed.)
Author(s):

Eelco F. M. Wijdicks

, Alejandro A. Rabinstein

, Sara E. Hocker

, and Jennifer E. Fugate

DOI:
10.1093/med/9780190602659.003.0033

Weaning from the mechanical ventilator after intubation following treatment for myasthenic crisis is difficult. There is a high probability of reintubation, especially in patients with bronchial hypersecretion and atelectasis. Long-term management with placement of a tracheostomy is needed after reintubation. Strategies for successful weaning and extubation are discussed in this chapter. Plasma exchange is the preferred treatment in myasthenic patients with severe neuromuscular respiratory muscle weakness. Plasma exchange may not be sufficient, however, to wean a patient off the ventilator, and pyridostigmine is needed to improve respiratory muscle function. Finding an optimal dose of pyridostigmine after treatment of myasthenic crisis is difficult. There is a fine line between minimizing secretions and optimizing the strength of oropharyngeal and respiratory muscles.

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