scholarly journals Manajemen Perawatan Neurointensif pada Miastenia Gravis

2021 ◽  
Vol 1 (12) ◽  
pp. 1002-1010
Author(s):  
Dicki Apriansyah Haris Putra ◽  
Lale Sirin Rifdah S ◽  
Putu Mega Asri D ◽  
Muhammad Mahfuzzahroni
Keyword(s):  
Myasthenia Gravis ◽  
Surgical Therapy ◽  
Autoimmune Disorder ◽  
Myasthenic Crisis ◽  
Immunosuppressant Therapy ◽  
Ventilation Non Invasive ◽  
Short Term ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Motor End Plate

Myasthenia gravis (MG) is an autoimmune disorder that affects neuromuscular transmission, causing generalized or localized weakness characterized by fatigue. Myasthenia gravis is most commonly associated with antibodies to the acetylcholine receptor (AChR) on the motor end plate in the postsynaptic neuron. This article aims to determine the appropriate neurointensive management in patients with myasthenia gravis with complications of myasthenic crisis. The writing of this article includes various sources originating from scientific journals and government guidelines and related agencies. Source searches were carried out on online portals for journal publications such as MedScape, Google Scholar (scholar.google.com) and the National Center for Biotechnology Information (ncbi.nlm.nih.gov), with the keyword “Myasthenia Gravis”. The management of myasthenia gravis can be done in various ways, namely, mechanical intubation and ventilation, non-invasive ventilation, pridostigmine as an anticholinesterase inhibitor, immunosuppressant therapy, short term immunotherapy, intravenous immunoglobulin, and surgical therapy. In the treatment of myasthenia gravis, the main goal is to restore muscle condition, especially patient productivity where the management of myasthenia gravis consists of management of myasthenic crisis, cholinergic crisis, symptoms, immunosuppressant therapy, and thymectomy surgical therapy if a tumor is indicated.

scholarly journals What is optimal in patients with myasthenic crisis: Invasive or non-invasive ventilation?

2014 ◽  
Vol 01 (02) ◽  
pp. 116-120
Author(s):  
Hemant Bhagat ◽  
Vinod Grover ◽  
Kiran Jangra
Keyword(s):  
Neuromuscular Junction ◽  
Myasthenia Gravis ◽  
Respiratory Muscles ◽  
Myasthenic Crisis ◽  
Invasive Ventilation ◽  
Immune Disorder ◽  
Non Invasive ◽  
Advanced Form ◽  
Non Invasive Ventilation

AbstractMyasthenia gravis is an immune disorder involving the neuromuscular junction. The consequent weakness of respiratory muscles leads to variable disorders of ventilation in patients with myasthenia gravis. This article reviews the options of invasive and non-invasive ventilation in patients with advanced form of the disease.

scholarly journals Short-term effects of synchronized vs. non-synchronized NIPPV in preterm infants: study protocol for an unmasked randomized crossover trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Francesco Cresi ◽  
Federica Chiale ◽  
Elena Maggiora ◽  
Silvia Maria Borgione ◽  
Mattia Ferroglio ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Work Of Breathing ◽  
Respiratory Rhythm ◽  
Assisted Ventilation ◽  
Positive Pressure ◽  
Invasive Ventilation ◽  
Short Term ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Short Term Effects

Abstract Background Non-invasive ventilation (NIV) has been recommended as the best respiratory support for preterm infants with respiratory distress syndrome (RDS). However, the best NIV technique to be used as first intention in RDS management has not yet been established. Nasal intermittent positive pressure ventilation (NIPPV) may be synchronized (SNIPPV) or non-synchronized to the infant’s breathing efforts. The aim of the study is to evaluate the short-term effects of SNIPPV vs. NIPPV on the cardiorespiratory events, trying to identify the best ventilation modality for preterm infants at their first approach to NIV ventilation support. Methods An unmasked randomized crossover study with three treatment phases was designed. All newborn infants < 32 weeks of gestational age with RDS needing NIV ventilation as first intention or after extubation will be consecutively enrolled in the study and randomized to the NIPPV or SNIPPV arm. After stabilization, enrolled patients will be alternatively ventilated with two different techniques for two time frames of 4 h each. NIPPV and SNIPPV will be administered with the same ventilator and the same interface, maintaining continuous assisted ventilation without patient discomfort. During the whole duration of the study, the patient’s cardiorespiratory data and data from the ventilator will be simultaneously recorded using a polygraph connected to a computer. The primary outcome is the frequency of episodes of oxygen desaturation. Secondary outcomes are the number of the cardiorespiratory events, FiO2 necessity, newborn pain score evaluation, synchronization index, and thoracoabdominal asynchrony. The calculated sample size was of 30 patients. Discussion It is known that NIPPV produces a percentage of ineffective acts due to asynchronies between the ventilator and the infant’s breaths. On the other hand, an ineffective synchronization could increase work of breathing. Our hypothesis is that an efficient synchronization could reduce the respiratory work and increase the volume per minute exchanged without interfering with the natural respiratory rhythm of the patient with RDS. The results of this study will allow us to evaluate the effectiveness of the synchronization, demonstrating whether SNIPPV is the most effective non-invasive ventilation mode in preterm infants with RDS at their first approach to NIV ventilation. Trial registration ClinicalTrials.gov NCT03289936. Registered on September 21, 2017.

Short-term effects of non-invasive ventilation on cerebral blood flow and cognitive function in COPD

2018 ◽  
Vol 258 ◽  
pp. 53-59
Author(s):  
Marcelo A. Holanda ◽  
Mirizana Alves-de-Almeida ◽  
José W.O. Lima ◽  
Tauily C.D. Taunay ◽  
Francisco A.A. Gondim ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cognitive Function ◽  
Invasive Ventilation ◽  
Short Term ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Short Term Effects

The Role of Non-invasive Ventilation and Factors Predicting Extubation Outcome in Myasthenic Crisis

2008 ◽  
Vol 10 (1) ◽  
pp. 35-42 ◽  
Author(s):  
Jenn-Yu Wu ◽  
Ping-Hung Kuo ◽  
Pi-Chuan Fan ◽  
Huey-Dong Wu ◽  
Fuh-Yuan Shih ◽  
...  
Keyword(s):  
Myasthenic Crisis ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Extubation Outcome

scholarly journals Lung ultrasound as a predictor of mortality of patients with COVID-19

2021 ◽  
pp. e20210092
Author(s):  
Fernando A. Sosa1 ◽  
Agustín Matarrese1 ◽  
Santiago Saavedra1 ◽  
Javier Osatnik1 ◽  
Javier Roberti2 ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Lung Ultrasound ◽  
Area Under The Curve ◽  
Invasive Ventilation ◽  
High Flow Nasal Cannula ◽  
Short Term ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Reproducible Method ◽  
Score Range

Objective: To evaluate the performance of lung ultrasound to determine short-term outcomes of patients with COVID-19 admitted to the intensive care unit. Methods: This is a Prospective, observational study. Between July and November 2020, 59 patients were included and underwent at least two LUS assessments using LUS score (range 0-42) on day of admission, day 5th, and 10th of admission. Results: Age was 66.5±15 years, APACHE II was 8.3±3.9, 12 (20%) patients had malignancy, 46 (78%) patients had a non-invasive ventilation/high-flow nasal cannula and 38 (64%) patients required mechanical ventilation. The median stay in ICU was 12 days (IQR 8.5-20.5 days). ICU or hospital mortality was 54%. On admission, the LUS score was 20.8±6.1; on day 5th and day 10th of admission, scores were 27.6±5.5 and 29.4±5.3, respectively (P=0.007). As clinical condition deteriorated the LUS score increased, with a positive correlation of 0.52, P <0.001. Patients with worse LUS on day 5th versus better score had a mortality of 76% versus 33% (OR 6.29, 95%CI 2.01-19.65, p. 0.003); a similar difference was observed on day 10. LUS score of 5th day of admission had an area under the curve of 0.80, best cut-point of 27, sensitivity and specificity of 0.75 and 0.78 respectively. Conclusion: These findings position LUS as a simple and reproducible method to predict the course of COVID-19 patients.

scholarly journals Myasthenia Gravis Exacerbation and Myasthenic Crisis Associated With COVID19: Case Series and Literature Review.

2021 ◽  
Author(s):  
Cleonisio Leite Rodrigues ◽  
Hermany Capistrano Freitas ◽  
Paulo Reges Oliveira Lima ◽  
Pedro Helder de Oliveira Junior ◽  
José Marcelino Aragão Fernandes ◽  
...  
Keyword(s):  
Literature Review ◽  
Neuromuscular Junction ◽  
Hospital Mortality ◽  
Myasthenia Gravis ◽  
Viral Infections ◽  
Case Series ◽  
Previous Treatment ◽  
Autoimmune Disorder ◽  
Myasthenic Crisis

Abstract Myasthenia Gravis (MG) is an autoimmune disorder of the neuromuscular junction that can be exacerbated by many viral infections, including COVID19. Management of MG exacerbations is challenging in this scenario. We report 8 cases of MG exacerbation or myasthenic crisis associated with COVID19 and discuss prognosis and treatment based on a literature review. Most patients were female (7/8), with an average age of 47.1 years. Treatment was immunoglobulin (IVIG) in 3 patients, plasma exchange (PLEX) in 2 patients, and adjustment of baseline drugs in 3. In-hospital mortality was 25% and 37.5% in 2-month follow-up. This is the largest case series of MG exacerbation or myasthenic crisis due to COVID19 to this date. Mortality was considerably higher than in myasthenic crisis of other etiologies. Previous treatment for MG or acute exacerbation treatment did not seem to interfere with prognosis, although sample size was too small to draw definitive conclusions. Further studies are needed to understand the safety and effectiveness of interventions in this setting, particularly of PLEX, IVIG, rituximab and tocilizumab.

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