Respiratory failure & ventilation
Weaning from mechanical ventilation in myasthenic crisis according to WEAN safe: most patients experience intermediate or prolonged weaning with no differences between early and late-onset compared to very-late onset myasthenia Gravis
Authors' conclusion
In this retrospective study from a single expert center, most patients with myasthenic crisis underwent intermediate or prolonged weaning, but extubation failure rate was very low. Thymoma and lack of MG-specific immunosuppressive treatment at ICU admission are associated with prolonged weaning, while age alone is not.
Study context
- Population
- Patients admitted for myasthenic crisis to a tertiary neuro-ICU, 2008–2023, receiving invasive mechanical ventilationfinal analysis
- Participants
- 81 patients
- Exposure
- Early- and late-onset vs very-late-onset myasthenia gravis
- Outcome
- Weaning characteristics by WEAN Safe classification (short, intermediate, prolonged, failed wean)
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
- Short wean
- 3%
- Intermediate wean
- 40%
- Prolonged wean
- 55%
- Failed weaning
- 3%
- Median duration of mechanical ventilation, days [IQR]
- 20 [11-38]
- Median time from first separation attempt to successful weaning, days
- 7 [3-19]
Observational data: associations, not effects.
Further findings
Factors independently associated with prolonged weaning (multivariate analysis)
| OR (95% CI) | ||
|---|---|---|
| Presence of thymomaMultivariate analysis | 3.02 (1.01–9.07) | |
| Absence of MG-specific immunosuppressive treatment at ICU admissionMultivariate analysis | 3.70 (1.22–11.23) | |
| 0.050.21520Odds ratio (log scale) |
Mortality
- ICU mortality
- 7%
- 12-month mortality
- 19%
Myasthenic muscle score · 1 year
- Median myasthenic muscle score, /100 [80-100]
- 94
Weaning parameters and outcome, early- and late-onset (< 65 years) vs very-late-onset MG (≥ 65 years) (subgroup)
- No significant differences between early- and late-onset vs very-late-onset MG, despite more comorbidities in the very-late-onset group
Safety
Reintubation within 48 h
- Patients requiring reintubation
- 4 (5%)
VAP before first separation attempt
- VAP
- 15%
Original publication
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