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The repeated measurement of vital capacity is a poor predictor of the need for mechanical ventilation in myasthenia gravis

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Abstract

Objective

Testing the hypothesis that, in myasthenia gravis (MG), repeated measurements of vital capacity (VC) and various parameters derived from this measurement [median or lowest value of measured VCs during hospitalization, VC values<20ml/kg body weight (BW) or<13ml/kg BW, or an index assessing the variability of VC values during the whole ICU stay] could predict the need for intubation and mechanical ventilation (MV), as has been shown in other neuromuscular diseases with respiratory failure.Design: Retrospective study with medical chart revision of all the patients with MG and respiratory failure admitted to our intensive care unit between 1985 and 1993.Setting: Medical intensive care unit (15 beds) of a nuniversity hospital.Patients and methods: Five patients suffering from ten episodes of acute respiratory failure due to their decompensated MG. Repeated measurements of arterial blood gases and VC by trained respiratory therapists, at least every 4h.Results: There was no difference in any of these parameters between patients eventually requiring MV (four episodes) and those in whom mechanical ventilation was not necessary (six episodes).Conclusions: VC repeated measurements is a poor predictor of the need for further MV in MG patients. This can probably be ascribed to the erratic nature of MG, a disease whose course is largely influenced by many parameters (infection, treatment modifications, initiation of corticosteroid therapy, stress, psychological factors, etc.). Early admissions to the ICU of MG patients with respiratory dysfunction is thus recommended.

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References

  1. Graus Y, De Baets MH (1993) Myasthenia gravis: an autoimmune response against acetylcholine receptor. Immunol 12:78–100

    Google Scholar 

  2. Thorlacius S, Aarli JA, Riise T, Matre R, Johnsen HJ (1989) Associated disorders in myasthenia gravis: auto-immune diseases and their relation to thymectomy. Acta Neurol Scand 80:290–295

    Google Scholar 

  3. Ringqvist I, Ringqvist T (1971) Respiratory mechanics in untreated myasthenia gravis with special reference to the respiratory forces. Acta Med Scand 190: 499–508

    Google Scholar 

  4. Mier-Jedrzejowicz AK, Brophy C, Green M (1988) Respiratory muscle function in myasthenia gravis. Am Rev Respir Dis 138:867–873

    Google Scholar 

  5. Simpson J (1981) Myasthenia gravis and myasthenic syndromes. In: Walton J (ed) Disorders of voluntary muscles. Churchill Livingstone, Edinburgh, pp 585–624

    Google Scholar 

  6. Diez Tejedor E, Pino JM, Frank A, Blanco C, Cruz Martinez A (1990) Valoracion de la function muscular respiratoria (maximas presiones respiratorias) en miastenia gravis. Neurologia 5:310–314

    Google Scholar 

  7. Mier-Jedrzejowicz A, Brophy C, Moxham J, Green M (1986) Diaphragm weakness in myasthenia gravis. Bull Eur Physiopathol Respir [Suppl] 531

    Google Scholar 

  8. Ferguson IT, Murphy RP, Lascelles RG (1982) Ventilatory failure in myasthenia gravis. J Neurol Neurosurg Psychiatry 45:217–222

    Google Scholar 

  9. Osserman KE, Genkins G (1971) Studies in myasthenia gravis: review of a 20-year experience in over 1200 patients. Mt Sinaï J Med (NY) 38: 497–537

    Google Scholar 

  10. Macklem PT (1986) Muscular weakness and respiratory function. N Engl J Med 314:775–776

    Google Scholar 

  11. Braun NM, Arora NS, Rochester DF (1983) Respiratory muscle and pulmonary function in polymyositis and other proximal myopathies. Thorax 38: 616–623

    Google Scholar 

  12. De Troyer A, Borenstein S, Cordier R (1980) Analysis of lung volume restriction in patients with respiratory muscle weakness. Thorax 35:603–610

    Google Scholar 

  13. Eisenkraft JB, Papatestas AE, Kahn CH, Mora CT, Fagerstrom R, Genkins G (1986) Predicting the need for postoperative mechanical ventilation in myasthenia gravis. Anesthesiology 65: 79–82

    Google Scholar 

  14. d'Empaire G, Hoaglin DC, Perlo VP, Pontoppidan HJ (1985) Effect of prethymectomy plasma exchange on postoperative respiratory function in myasthenia gravis. J Thorac Cardiovasc Surg 89:592–596

    Google Scholar 

  15. Younger DS, Braun NM, Jaretzki A, Penn AS, Lovelace RE (1984) Myasthenia gravis: determinants for independent ventilation after transsternal thymectomy. Neurology 34:336–340

    Google Scholar 

  16. Chevrolet JC, Deléamont P (1991) Repeated vital capacity measurements as predictive parameters for mechanical ventilation need and weaning success in the Guillain-Barré syndrome. Am Rev Respir Dis 144:814–818

    Google Scholar 

  17. Oesterhuis H (1993) Diagnosis and differential diagnosis. In: Baets MH de, Oesterhuis H (eds) Myasthenia gravis. CRC Press, Boca Raton, Fla, pp 203–234

    Google Scholar 

  18. Litchfield M, Noroian E (1989) Changes in selected pulmonary functions in patients diagnosed with myasthenia gravis. J Neurosci Nurs 21:375–381

    Google Scholar 

  19. Spinelli A, Marconi G, Gorini M, Pizzi A, Scano G (1992) Control of breathing in patients with myasthenia gravis. Am Rev Respir Dis 145:1359–1366

    Google Scholar 

  20. Borel C, Teitelbaum J, Hanley D (1993) Ventilatory drive and carbon dioxide response in ventilatory failure due to myasthenia gravis and Guillain-Barré syndrome. Crit Care Med 21: 1717–1726

    Google Scholar 

  21. Borel C, Tilford C, Nichols DG, Hanley D, Traystman RJ (1991) Diaphragmatic performance during recovery from acute ventilatory failure in Guillain-Barré syndrome and myasthenia gravis. Chest 99:435–451

    Google Scholar 

  22. Vincken W, Ghezzo H, Cosio M (1987) Maximal static respiratory pressures in adults: normal values and their relationship to determinants of respiratory function. Bull Eur Physiopathol Respir 23:435–439

    Google Scholar 

  23. Cohen C, Zagelbaum G, Gross D, Roussos C, Macklem PT (1982) Clinical manifestations of inspiratory muscle fatigue. Am J Med 73:308–316

    Google Scholar 

  24. Koulouris N, Mulvey DA, Laroche CM, Sawicka EH, Green M, Moxham J (1989) The measurement of inspiratory muscle strength by sniff oesophageal, nasopharyngeal and mouth pressures. Am Rev Respir Dis 139:641–646

    Google Scholar 

  25. Gracey DR, Divertie MB, Howard FM (1983) Mechanical ventilation for respiratory failure in myasthenia gravis. Mayo Clin Proc 58:597–602

    Google Scholar 

  26. Kirsch JR, Diringer MN, Borel CO, Hanley DF, Merritt WT, Bulkey GB (1991) Preoperative lumbar epidural morphine improves postoperative analgesia and ventilatory function after transsternal thymectomy in patients with myasthenia gravis. Crit Care Med 19:1474–1479

    Google Scholar 

  27. Leventhal R, Orkin FK, Hirsch RA (1980) Prediction of the need for postoperative mechanical ventilation in myasthenia gravis. Anesthesiology 53: 26–30

    Google Scholar 

  28. Gracey DR, Divertie MB, Howard FM, Payne WS (1984) Postoperative respiratory care after transsternal thymectomy in myasthenia gravis. Chest 86:67–71

    Google Scholar 

  29. Gorback MS, Moon RE, Massey JM (1991) Extubation after transsternal thymectomy for myasthenia gravis: a prospective analysis. South Med J 84: 701–706

    Google Scholar 

  30. Aubier M, Murciano D, Fournier M, Pariente R (1980) Gentral respiratory drive in acute respiratory failure of patients with chronic obstructive respiratory disease. Am Rev Respir Dis 12: 191–199

    Google Scholar 

  31. Roussos C, Macklem PT (1986) Inspiratory muscle fatigue. In: Macklem PT, Mead J (eds) Handbook of physiology: The respiratory system, vol III/2. American Physiological Society, Bethesda, pp 511–527

    Google Scholar 

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Authors and Affiliations

  1. Medical Intensive Care Unit, Department of Internal Medicine, University Hospital, CH-1211, Geneva 4, Switzerland

    P. Rieder, P. Jolliet & J. -C. Chevrolet

  2. Medical Clinic I, Geheva University Hospital, Geneva, Switzerland

    M. Louis

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  1. P. Rieder
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  2. M. Louis
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  3. P. Jolliet
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  4. J. -C. Chevrolet
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Rieder, P., Louis, M., Jolliet, P. et al. The repeated measurement of vital capacity is a poor predictor of the need for mechanical ventilation in myasthenia gravis. Intensive Care Med 21, 663–668 (1995). https://doi.org/10.1007/BF01711545

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  • DOI: https://doi.org/10.1007/BF01711545

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