Department of Neurology, Donau-Isar-Klinikum Deggendorf, Deggendorf, Germany.
Department of Neurology, University Medical Center Regensburg, Regensburg, Germany.
J Neurol. 2024 Jan;271(1):564-574. doi: 10.1007/s00415-023-12016-2. Epub 2023 Nov 3.
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.
肌无力危象（MC）需要机械通气是重症肌无力（MG）的严重并发症。在这里，我们分析了在 12 个德国神经科部门治疗的 MC 患者中，撤机和拔管失败的频率和危险因素，以及其对临床病程的影响。我们对 2006 年至 2015 年间在 12 个德国神经科部门治疗的 MC 患者进行了回顾性图表审查。撤机失败（WF）定义为阴性自主呼吸试验、原发性气管切开术或拔管失败（EF）（重新插管或死亡）。WF 发生在 138 个病例中（64.2%）。年龄较大（p=0.039）、合并多种疾病（≥3 种）（p=0.007，OR=4.04）、晚发性 MG（p=0.004，OR=2.84）、并发症，如肺不张（p=0.008，OR=3.40）、肺炎（p<0.0001，OR=3.45）、心肺复苏（p=0.005，OR=5.00）和败血症（p=0.02，OR=2.57）与 WF 相关。在接受静脉免疫球蛋白（IVIG）治疗的患者中，WF 发生率较高（p=0.002，OR=2.53），而在接受血浆置换或免疫吸附作为一线治疗的患者中，WF 发生率较低（p=0.07，OR=0.57）。首次拔管尝试后，在 135 个病例中有 58 个发生 EF（43.0%），EF 与机械通气时间延长、重症监护病房停留时间和住院时间延长有关（p≤0.0001）。在插管后 7 至 12 天之间的拔管时间窗内，拔管成功率最高（p=0.06，OR=2.12）。我们得出结论，WF 和 EF 在 MC 中非常常见，与不良预后相关。年龄较大、合并多种疾病以及心脏和肺部并发症的发生与 WF 和 EF 的风险增加相关。我们的数据表明，与一线使用 IVIG 相比，WF 在一线使用血浆置换/免疫吸附时发生频率较低。
