Use of non invasive ventilation to avoid re-intubation in myasthenia gravis; a case report and review of literature.

Myasthenia Gravis (MG) in the elderly is an uncommon finding, especially when it is not related to thymoma. A case is presented with late onset Myasthenia Gravis treated with steroids, immunosuppressives and mechanical ventilation. This 61 year Asian hypertensive lady clinically diagnosed as MG presented to emergency room with difficulty in swallowing liquid, diplopia, drooping of eyelids and generalized weakness.Within 24 hours in the ward developed respiratory distress and CO2 narcosis, for which she was immediately intubated and shifted to ICU and managed by invasive ventilation and inotropic support. After stabilization and extubation BiPAP was applied successfully. BiPAP use is an established, non invasive ventilation technique for Myasthenia Gravis. Its application to avoid reintubation has not been thoroughly investigated. We intend to highlight this area for further research as it may change the total length of ICU and hospital stay and more importantly the outcome for this subset of patients.