Predictors of extubation failure in myasthenic crisis

Janaka Seneviratne, Jayawant Mandrekar, Eelco F M Wijdicks, Alejandro Rabinstein

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Background: The ideal timing for extubation of patients with myasthenic crisis (MC) and the factors that influence extubation outcome are not well established. Objectives: To assess the risk of extubation failure in MC and to identify predictors of extubation failure. Design: We reviewed consecutive episodes of MC treated with endotracheal intubation from January 1, 1987, through December 31, 2006. Setting: Mayo Clinic. Patients: Forty patients with 46 episodes of MC underwent endotracheal intubation and mechanical ventilation. Main Outcome Measures: The main outcome measures were extubation failure and reintubation. Extubation failure was defined as reintubation, tracheostomy, or death while intubated. Reintubation was also analyzed as a separate end point. Univariate logistic regression was used to identify predictors of extubation failure and reintubation. Results: Of the 46 episodes of MC, extubation failure occurred in 20 (44%), including 9 of 35 episodes (26%) of reintubation. Male sex, history of previous crisis, atelectasis, and intubation for more than 10 days were associated with extubation failure. Lower pH and lower forced vital capacity on the time of extubation, atelectasis, and bilevel intermittent positive airway pressure use after extubation predicted the need for reintubation. Atelectasis showed the strongest association with both end points. Extubation failure and reintubation were associated with significant prolongation in intensive care unit and hospital length of stay. Conclusions: Extubation failure is relatively common in patients with MC. Atelectasis is the strongest predictor of this complication.

Original languageEnglish (US)
Pages (from-to)929-933
Number of pages5
JournalArchives of Neurology
Volume65
Issue number7
DOIs
StatePublished - Jul 2008

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Muscle Weakness
Pulmonary Atelectasis
Intratracheal Intubation
Length of Stay
Outcome Assessment (Health Care)
Tracheostomy
Vital Capacity
Artificial Respiration
Intubation
Intensive Care Units
Predictors
Logistic Models
Pressure

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Predictors of extubation failure in myasthenic crisis. / Seneviratne, Janaka; Mandrekar, Jayawant; Wijdicks, Eelco F M; Rabinstein, Alejandro.

In: Archives of Neurology, Vol. 65, No. 7, 07.2008, p. 929-933.

Research output: Contribution to journalArticle

Seneviratne, Janaka ; Mandrekar, Jayawant ; Wijdicks, Eelco F M ; Rabinstein, Alejandro. / Predictors of extubation failure in myasthenic crisis. In: Archives of Neurology. 2008 ; Vol. 65, No. 7. pp. 929-933.
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