Angstwurm, Klemens, Vidal, Amelie, Stetefeld, Henning, Dohmen, Christian, Mergenthaler, Philipp, Kohler, Siegfried, Schonenberger, Silvia, Bosel, Julian, Neumann, Ursula, Lee, De-Hyung, Gerner, Stefan T. ORCID: 0000-0001-6020-8290, Huttner, Hagen B., Thieme, Andrea, Dunkel, Juliane, Roth, Christian, Schneider, Hauke ORCID: 0000-0002-9641-0922, Schimmel, Eik, Reichmann, Heinz, Fuhrer, Hannah, Berger, Benjamin ORCID: 0000-0003-2654-2898, Kleiter, Ingo ORCID: 0000-0002-8249-4408, Schneider-Gold, Christiane, Alberty, Anke, Zinke, Jan, Schalke, Berthold, Steinbrecher, Andreas, Meisel, Andreas ORCID: 0000-0001-7233-5342 and Neumann, Bernhard (2022). Early Tracheostomy Is Associated With Shorter Ventilation Time and Duration of ICU Stay in Patients With Myasthenic Crisis-A Multicenter Analysis. J. Intensive Care Med., 37 (1). S. 32 - 41. THOUSAND OAKS: SAGE PUBLICATIONS INC. ISSN 1525-1489

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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.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Angstwurm, KlemensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vidal, AmelieUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stetefeld, HenningUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dohmen, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mergenthaler, PhilippUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kohler, SiegfriedUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schonenberger, SilviaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bosel, JulianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Neumann, UrsulaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lee, De-HyungUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gerner, Stefan T.UNSPECIFIEDorcid.org/0000-0001-6020-8290UNSPECIFIED
Huttner, Hagen B.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Thieme, AndreaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dunkel, JulianeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Roth, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schneider, HaukeUNSPECIFIEDorcid.org/0000-0002-9641-0922UNSPECIFIED
Schimmel, EikUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reichmann, HeinzUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fuhrer, HannahUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Berger, BenjaminUNSPECIFIEDorcid.org/0000-0003-2654-2898UNSPECIFIED
Kleiter, IngoUNSPECIFIEDorcid.org/0000-0002-8249-4408UNSPECIFIED
Schneider-Gold, ChristianeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Alberty, AnkeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zinke, JanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schalke, BertholdUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Steinbrecher, AndreasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Meisel, AndreasUNSPECIFIEDorcid.org/0000-0001-7233-5342UNSPECIFIED
Neumann, BernhardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-695482
DOI: 10.1177/0885066620967646
Journal or Publication Title: J. Intensive Care Med.
Volume: 37
Number: 1
Page Range: S. 32 - 41
Date: 2022
Publisher: SAGE PUBLICATIONS INC
Place of Publication: THOUSAND OAKS
ISSN: 1525-1489
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
PROLONGED ENDOTRACHEAL INTUBATION; MECHANICAL VENTILATION; GRAVIS EXACERBATION; EXTUBATION FAILURE; CLINICAL-FEATURES; PLASMA-EXCHANGE; TRACHEOTOMY; STROKE; IMMUNOGLOBULIN; PREDICTIONMultiple languages
Critical Care MedicineMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/69548

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