Neumann, Bernhard and Angstwurm, Klemens and Dohmen, Christian and Mergenthaler, Philipp and Kohler, Siegfried and Schoenenberger, Silvia and Lee, De-Hyung and Gerner, Stefan T. and Huttner, Hagen B. and Thieme, Andrea and Steinbrecher, Andreas and Dunkel, Juliane and Roth, Christian and Schneider, Hauke and Reichmann, Heinz and Fuhrer, Hannah and Kleiter, Ingo and Schneider-Gold, Christiane and Alberty, Anke and Zinke, Jan and Schroeter, Michael and Linker, Ralf and Meisel, Andreas and Boesel, Julian and Stetefeld, Henning R. (2023) Weaning and extubation failure in myasthenic crisis: a multicenter analysis. SPRINGER HEIDELBERG, HEIDELBERG.
Full text not available from this repository. (Request a copy)Abstract
Myasthenic crisis (MC) requiring mechanical ventilation is a serious complication of myasthenia gravis (MG). Here we analyze the frequency and risk factors of weaning- and extubation failure as well as its impact on the clinical course in a large cohort. We performed a retrospective chart review on patients treated for MC in 12 German neurological departments between 2006 and 2015. Weaning failure (WF) was defined as negative spontaneous breathing trial, primary tracheostomy, or extubation failure (EF) (reintubation or death). WF occurred in 138 episodes (64.2%). Older Age (p = 0.039), multiple comorbidities (>= 3) (p = 0.007, OR = 4.04), late-onset MG (p = 0.004, OR = 2.84), complications like atelectasis (p = 0.008, OR = 3.40), pneumonia (p < 0.0001, OR = 3.45), cardio-pulmonary resuscitation (p = 0.005, OR = 5.00) and sepsis (p = 0.02, OR = 2.57) were associated with WF. WF occurred often in patients treated with intravenous immungloblins (IVIG) (p = 0.002, OR = 2.53), whereas WF was less often under first-line therapy with plasma exchange or immunoadsorption (p = 0.07, OR = 0.57). EF was observed in 58 of 135 episodes (43.0%) after first extubation attempt and was related with prolonged mechanical ventilation, intensive care unit stay and hospital stay (p <= 0.0001 for all). Extubation success was most likely in a time window for extubation between day 7 and 12 after intubation (p = 0.06, OR = 2.12). We conclude that WF and EF occur very often in MC and are associated with poor outcome. Older age, multiple comorbidities and development of cardiac and pulmonary complications are associated with a higher risk of WF and EF. Our data suggest that WF occurs less frequently under first-line plasma exchange/immunoadsorption compared with first-line use of IVIG.
| Item Type: | Other |
|---|---|
| Uncontrolled Keywords: | CLINICAL-FEATURES; PLASMA-EXCHANGE; RISK-FACTORS; CARE; GRAVIS; MORTALITY; VENTILATION; Myasthenia gravis; Myasthenic crisis; Weaning failure; Extubation failure |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Neurologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 07 May 2024 06:03 |
| Last Modified: | 07 May 2024 06:03 |
| URI: | https://pred.uni-regensburg.de/id/eprint/60844 |
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