title: Predictors of extubation outcomes following myasthenic crisis.
abstract: Objective Myasthenic crisis (MC) is considered the most severe adverse event in patients with myasthenia gravis. The present retrospective study was performed to evaluate the predictors of clinical outcomes in patients with MC. Methods The medical charts of 33 patients (19 women, 14 men) with 76 MC attacks from 2002 to 2014 were retrospectively reviewed. Early extubation (≤7 days) and prolonged ventilation (>15 days) during the MC were used to assess patient outcomes. Results Among the 33 patients, 24 (72.7%) had positive acetylcholine receptor antibody test results and 20 (60.6%) experienced recurrent MC attacks (≥2 episodes) during follow-up (median 83.6 months, range 1.5-177 months). Plasma exchange during an MC was significantly associated with early extubation. Male sex, older age (>50 years), atelectasis, and ventilator-associated pneumonia significantly contributed to prolonged ventilation. In 22 patients who underwent thymectomy, both the duration between MC attacks and the mean number of MC attacks were significantly reduced after surgery. Conclusions Plasma exchange during MC attacks was found to be important for early extubation; older patients and those with atelectasis or ventilator-associated pneumonia were more vulnerable to prolonged ventilation. Thymectomy may be useful to prevent recurrence of MC.
authors.affiliation: 1 Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Zhenguo
authors.initials: Z
authors.lastname: Liu
authors.affiliation: 1 Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Shiyuan
authors.initials: S
authors.lastname: Yao
authors.affiliation: 2 Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhou
authors.affiliation: 1 Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Zhensheng
authors.initials: Z
authors.lastname: Deng
authors.affiliation: 1 Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Jianyong
authors.initials: J
authors.lastname: Zou
authors.affiliation: 3 Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Huiyu
authors.initials: H
authors.lastname: Feng
authors.affiliation: 4 Department of Surgery, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Hua
authors.initials: H
authors.lastname: Zhu
authors.affiliation: 1 Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Chao
authors.initials: C
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D060666:Airway Extubation; D001323:Autoantibodies / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007442:Intubation, Intratracheal; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D010951:Plasma Exchange; D011379:Prognosis; D011950:Receptors, Cholinergic / Q000097:blood; D012121:Respiration, Artificial / Q000295:instrumentation; D012131:Respiratory Insufficiency / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D012189:Retrospective Studies; D012737:Sex Factors; D013934:Thymectomy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D011950:Receptors, Cholinergic
keywords: Myasthenia gravis; early extubation; myasthenic crisis; plasma exchange; prolonged ventilation; surgery; thymectomy