Long-term mechanical ventilation in a myasthenic patient with suspected obstructive sleep apnea

Abstract

Myasthenic crisis is a medical emergency with a very poor prognosis if not treated early and appropriately. In the absence of mechanical ventilation, the respiratory impairment is the most serious aspect of the condition, leading the intensive care anaesthetist to resort to intubation. The association of this disease with sleep apnea syndrome is frequent but little-known, and can make it difficult to disconnect the patient from the ventilator. Making the diagnosis of sleep apnea syndrome is difficult because of polysomnography, which is laborious to set up in intensive care, but can be facilitated by the use of a simple questionnaire when there is a strong clinical suspicion. Weaning a patient suffering from neuromuscular disease, whether or not associated with sleep apnea syndrome from mechanical ventilation can be a complex task. When extubation proves impossible, tracheostomy remains the most desirable alternative. The introduction of long-term mechanical ventilation at home is an interesting solution for shortening the long hospital stay of patients in intensive care units, and significantly reduces the risk of infection, morbidity and mortality.