Myasthenic attack and ventilatory assistance: a tracheostomy is necessary in half of the cases

Myasthenia gravis (MG) is an autoimmune neuromuscular disease linked to the deleterious action of autoantibodies directed against elements of the neuromuscular junction. The majority of MG is related to dysfunction of the acetylcholine receptor. It can take a dramatic turn in the form of an acute myasthenic attack, sometimes fatal, requiring intensive care or even ventilatory assistance. 

In an article published in November 2020, German specialists report their experience in intensive care and its modalities. Their retrospective study involved 215 episodes of myasthenic attack, half of them required mechanical ventilation through a tracheostomy tube. This situation rather concerned patients with late onset MG and patients with significant co-morbidities. The authors also emphasize that if a tracheostomy is necessary, it is better to propose it early, preferably before the tenth day, in order to significantly shorten the length of stay in intensive care and the load in intensive care. 


Early Tracheostomy Is Associated With Shorter Ventilation Time and Duration of ICU Stay in Patients With Myasthenic Crisis-A Multicenter Analysis. K Angstwurm, A Vidal, H Stetefeld et al. J Intensive Care Med. 2020 (Nov). 885066620967646.