Department of Neurology, University Medical Center Regensburg, Regensburg, Germany.
Department of Neurology, University of Cologne, Cologne, Germany.
J Intensive Care Med. 2022 Jan;37(1):32-40. doi: 10.1177/0885066620967646. Epub 2020 Nov 25.
Myasthenic crisis (MC) requiring mechanical ventilation (MV) is a rare and serious complication of myasthenia gravis. Here we analyzed the frequency of performed tracheostomies, risk factors correlating with a tracheostomy, as well as the impact of an early tracheostomy on ventilation time and ICU length of stay (LOS) in MC.
Retrospective chart review on patients treated for MC in 12 German neurological departments between 2006 and 2015 to assess demographic/diagnostic data, rates and timing of tracheostomy and outcome.
In 107 out of 215 MC (49.8%), a tracheostomy was performed. Patients without tracheostomy were more likely to have an early-onset myasthenia gravis (27 [25.2%] vs 12 [11.5%], p = 0.01). Patients receiving a tracheostomy, however, were more frequently suffering from multiple comorbidities (20 [18.7%] vs 9 [8.3%], p = 0.03) and also the ventilation time (34.4 days ± 27.7 versus 7.9 ± 7.8, p < 0.0001) and ICU-LOS (34.8 days ± 25.5 versus 12.1 ± 8.0, p < 0.0001) was significantly longer than in non-tracheostomized patients. Demographics and characteristics of the course of the disease up to the crisis were not significantly different between patients with an early (within 10 days) compared to a late tracheostomy. However, an early tracheostomy correlated with a shorter duration of MV at ICU (26.2 days ± 18.1 versus 42.0 ± 33.1, p = 0.006), and ICU-LOS (26.2 days ± 14.6 versus 42.3 ± 33.0, p = 0.003).
Half of the ventilated patients with MC required a tracheostomy. Poorer health condition before the crisis and late-onset MG were associated with a tracheostomy. An early tracheostomy (≤ day 10), however, was associated with a shorter duration of MV and ICU-LOS by 2 weeks.
需要机械通气（MV）的肌无力危象（MC）是重症肌无力的一种罕见且严重的并发症。在此，我们分析了在 12 家德国神经科病房中治疗的 MC 患者中进行气管切开术的频率、与气管切开术相关的危险因素，以及早期气管切开术对 MC 患者 MV 时间和 ICU 住院时间（LOS）的影响。
对 2006 年至 2015 年期间在 12 家德国神经科病房治疗的 MC 患者进行回顾性图表审查，以评估人口统计学/诊断数据、气管切开术的发生率和时机以及结局。
在 215 例 MC 患者中有 107 例（49.8%）接受了气管切开术。未接受气管切开术的患者更有可能患有早发性重症肌无力（27 [25.2%] 例比 12 [11.5%] 例，p = 0.01）。然而，接受气管切开术的患者更常患有多种合并症（20 [18.7%] 例比 9 [8.3%] 例，p = 0.03），并且通气时间（34.4 天 ± 27.7 天比 7.9 ± 7.8 天，p < 0.0001）和 ICU-LOS（34.8 天 ± 25.5 天比 12.1 ± 8.0 天，p < 0.0001）也明显更长。与未气管切开的患者相比，气管切开术患者的人口统计学和疾病病程特征在危机前 10 天内并无显著差异。然而，早期（10 天内）气管切开术与 ICU 机械通气时间（26.2 天 ± 18.1 天比 42.0 ± 33.1 天，p = 0.006）和 ICU-LOS（26.2 天 ± 14.6 天比 42.3 ± 33.0 天，p = 0.003）较短相关。
一半需要 MV 的 MC 患者需要气管切开术。在危机前健康状况较差和晚发性 MG 与气管切开术相关。然而，早期气管切开术（≤第 10 天）与 MV 时间和 ICU-LOS 缩短 2 周相关。
