Management of mechanical ventilation and weaning in critically ill patients with neuromuscular disorders

Purpose

Myasthenia-gravis and Guillain-Barre-syndrome are two of the most common causes of acute and reversible neuromuscular-respiratory-failure(ARNRF), both may worsen respiratory-failure and need for invasive-mechanical-ventilation(IMV) for long-periods due to muscle-weakness. However, approitive IMV-mode for ARNRF patients that better gas-exchange and weaning in ARNRF remain unclear.

Materials and methods

Critically-ill-patiens with IMV due to ARNRF, who could meet the weaning-criterias (after intubation for more than 7-days; difficult-weaning), between 2013, and 2023 were included in the study. IMV-settings, simultaneous arterial-blood-gas (ABG) analyses, and prognosis were recorded for each patient on relevant days.

Results

Sixty-critically-ill-patients with ARNRF who defined as difficult-weaning were included in the study. When different IMV-modes were used in the same patient, simultaneous ABG results were compared for each ventilation-mode. It was determined that the partial-pressure-of-oxygen/fraction of inspired-oxygen-ratios were significantly higher and partial-carbon-dioxide-levels were significantly lower when critically-ill-patients were ventilated with the biphasic-positive-airway-pressure-ventilation(BIPAP) (95 % CI: [0.641–1.41]; p < .001; 95 % CI: [-1.05-.351]; p < .001, respectively). Length-of-time-until-weaning was significantly shorter in BIPAP-mode for each patient in the study group(95 % CI: [0.717–0.188]; p < .001). Moreover, weaning-success was statistically higher in patients with ARNRF were ventilated with BIPAP one-week-before spontenous-breathing-trial (95 % CI [1.026–21.65]; p = .046) than with all other IMV-modes.

Conclusion

According to our findings, when BIPAP was selected as the IMV-settings, gas exchange was improved,and weaning-success was higher in critically-ill-patients with ARNRF.