Klemens Angstwurm1, Amelie Vidal1, Henning Stetefeld2, Christian Dohmen2,3, Philipp Mergenthaler4,5,6, Siegfried Kohler4,6, Silvia Schönenberger7, Julian Bösel7,8, Ursula Neumann9, De-Hyung Lee1,10, Stefan T Gerner10, Hagen B Huttner10, Andrea Thieme11, Juliane Dunkel12, Christian Roth12, Hauke Schneider13,14, Eik Schimmel13,15, Heinz Reichmann13, Hannah Fuhrer16, Benjamin Berger16, Ingo Kleiter17,18, Christiane Schneider-Gold17, Anke Alberty19, Jan Zinke20, Berthold Schalke1, Andreas Steinbrecher11, Andreas Meisel4,5,6, Bernhard Neumann1. 1. Department of Neurology, University Medical Center Regensburg, Regensburg, Germany. 2. Department of Neurology, University of Cologne, Cologne, Germany. 3. Department of Neurology, LVR-Klinik Bonn, Bonn, Germany. 4. NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin. 5. Departments of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin. 6. Berlin Institute of Health (BIH), Berlin, Germany. 7. Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany. 8. Department of Neurology, Klinikum Kassel, Kassel, Germany. 9. Department of Mathematics and Computer Science, Philipps-Universitaet Marburg, Marburg, Germany. 10. Department of Neurology, University Hospital Erlangen, Erlangen, Germany. 11. Department of Neurology, HELIOS Klinikum Erfurt, Erfurt, Germany. 12. Department of Neurology, DRK-Kliniken Nordhessen, Kassel, Germany. 13. Department of Neurology, University Hospital, Technische Universität Dresden, Dresden, Germany. 14. Department of Neurology, University Hospital Augsburg, Augsburg, Germany. 15. Department of Neurology, Staedtisches Klinikum Dresden, Dresden, Germany. 16. Department of Neurology, Medical Center-University of Freiburg, Germany. 17. Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany. 18. Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany. 19. Department of Neurology, Kliniken Maria Hilf GmbH Moenchengladbach, Mönchengladbach, Germany. 20. Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.
Abstract
BACKGROUND: Myasthenic crisis (MC) requiring mechanical ventilation (MV) is a rare and serious complication of myasthenia gravis. Here we analyzed the frequency of performed tracheostomies, risk factors correlating with a tracheostomy, as well as the impact of an early tracheostomy on ventilation time and ICU length of stay (LOS) in MC. METHODS: Retrospective chart review on patients treated for MC in 12 German neurological departments between 2006 and 2015 to assess demographic/diagnostic data, rates and timing of tracheostomy and outcome. RESULTS: In 107 out of 215 MC (49.8%), a tracheostomy was performed. Patients without tracheostomy were more likely to have an early-onset myasthenia gravis (27 [25.2%] vs 12 [11.5%], p = 0.01). Patients receiving a tracheostomy, however, were more frequently suffering from multiple comorbidities (20 [18.7%] vs 9 [8.3%], p = 0.03) and also the ventilation time (34.4 days ± 27.7 versus 7.9 ± 7.8, p < 0.0001) and ICU-LOS (34.8 days ± 25.5 versus 12.1 ± 8.0, p < 0.0001) was significantly longer than in non-tracheostomized patients. Demographics and characteristics of the course of the disease up to the crisis were not significantly different between patients with an early (within 10 days) compared to a late tracheostomy. However, an early tracheostomy correlated with a shorter duration of MV at ICU (26.2 days ± 18.1 versus 42.0 ± 33.1, p = 0.006), and ICU-LOS (26.2 days ± 14.6 versus 42.3 ± 33.0, p = 0.003). CONCLUSION: Half of the ventilated patients with MC required a tracheostomy. Poorer health condition before the crisis and late-onset MG were associated with a tracheostomy. An early tracheostomy (≤ day 10), however, was associated with a shorter duration of MV and ICU-LOS by 2 weeks.
BACKGROUND: Myasthenic crisis (MC) requiring mechanical ventilation (MV) is a rare and serious complication of myasthenia gravis. Here we analyzed the frequency of performed tracheostomies, risk factors correlating with a tracheostomy, as well as the impact of an early tracheostomy on ventilation time and ICU length of stay (LOS) in MC. METHODS: Retrospective chart review on patients treated for MC in 12 German neurological departments between 2006 and 2015 to assess demographic/diagnostic data, rates and timing of tracheostomy and outcome. RESULTS: In 107 out of 215 MC (49.8%), a tracheostomy was performed. Patients without tracheostomy were more likely to have an early-onset myasthenia gravis (27 [25.2%] vs 12 [11.5%], p = 0.01). Patients receiving a tracheostomy, however, were more frequently suffering from multiple comorbidities (20 [18.7%] vs 9 [8.3%], p = 0.03) and also the ventilation time (34.4 days ± 27.7 versus 7.9 ± 7.8, p < 0.0001) and ICU-LOS (34.8 days ± 25.5 versus 12.1 ± 8.0, p < 0.0001) was significantly longer than in non-tracheostomized patients. Demographics and characteristics of the course of the disease up to the crisis were not significantly different between patients with an early (within 10 days) compared to a late tracheostomy. However, an early tracheostomy correlated with a shorter duration of MV at ICU (26.2 days ± 18.1 versus 42.0 ± 33.1, p = 0.006), and ICU-LOS (26.2 days ± 14.6 versus 42.3 ± 33.0, p = 0.003). CONCLUSION: Half of the ventilated patients with MC required a tracheostomy. Poorer health condition before the crisis and late-onset MG were associated with a tracheostomy. An early tracheostomy (≤ day 10), however, was associated with a shorter duration of MV and ICU-LOS by 2 weeks.