Wu J.-Y.PING-HUNG KUOPI-CHUAN FANHUEY-DONG WUFUH-YUAN SHIHPAN-CHYR YANG2020-03-232020-03-2320091541-6933https://scholars.lib.ntu.edu.tw/handle/123456789/478050Introduction: Myasthenic crisis is a great threat to patients with myasthenia gravis. Usage of non-invasive ventilation (NIV) to prevent intubation and timing of extubating of patients in myasthenic crisis are important issues though not well documented. Methods: To explore the factors predicting NIV success and extubation outcome in myasthenic crisis, we reviewed the records of 41 episodes of myasthenia crisis. Results: NIV was applied to 14 episodes of myasthenic crisis and eight (57.1%) of them were successfully prevented from intubation. An Acute Physiology and Chronic Health Evaluation (APACHE) II score of <6 and a serum bicarbonate level of <30 mmol/l were independent predictors of NIV success. For patients undergoing invasive mechanical ventilation, extubation failure was observed in 13 (39.4%) of 33 episodes, and the most common cause was sputum impaction due to a poor cough strength (61.5%). A maximal expiratory pressure (Pemax) of ?40 cmH2O was a good predictor of extubation success. Extubation failure led to poorer outcomes. Conclusions: NIV may be applied to those patients with a low APACHE II score and a lesser degree of metabolic compensation for respiratory acidosis. For patients undergoing invasive mechanical ventilation, extubation failure is associated with significant in-hospital morbidity in myasthenic crisis. Adequate levels of Pemax and cough strength correlate significantly with extubation success. ? 2007 Humana Press Inc.[SDGs]SDG3bicarbonate; immunosuppressive agent; steroid; adult; APACHE; article; assisted ventilation; bicarbonate blood level; clinical article; coughing; extubation; female; human; intubation; male; medical record review; myasthenia; myasthenic crisis; non invasive procedure; outcome assessment; plasmapheresis; prediction; priority journal; sputum; treatment failure; aged; artificial ventilation; cohort analysis; endotracheal intubation; intensive care; methodology; middle aged; myasthenia gravis; prediction and forecasting; respiratory failure; retrospective study; risk factor; treatment outcome; Aged; Cohort Studies; Female; Humans; Intensive Care; Intubation, Intratracheal; Male; Middle Aged; Myasthenia Gravis; Predictive Value of Tests; Respiration, Artificial; Respiratory Insufficiency; Retrospective Studies; Risk Factors; Treatment Outcomejournal article10.1007/s12028-008-9139-y188106632-s2.0-63249108477