Does myasthenia gravis require Ventilatory assistance devices?

Yes.

Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disease that causes weakness and rapid fatigue of skeletal muscles, including the muscles involved in breathing. As the condition worsens, the involvement of respiratory muscles can lead to respiratory failure, a life-threatening condition where the body is unable to meet its oxygen demands. In this situation, mechanical ventilatory assistance (or breathing support) devices are required to aid breathing and maintain adequate oxygen levels.

Ventilatory assistance involves the use of external devices to support or replace spontaneous breathing. Different types of ventilatory devices may be used, depending on the severity of respiratory compromise. These devices can include:

1. Non-invasive ventilation (NIV): NIV involves the use of a mask or nasal interface to deliver pressurized air to the lungs, supporting breathing while avoiding the need for intubation. Common NIV devices include continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP).

2. Invasive mechanical ventilation: In more severe cases, where NIV is inadequate or unsuccessful, invasive mechanical ventilation is used. This involves inserting a tube (endotracheal tube or tracheostomy tube) into the trachea to directly deliver breaths. The ventilator controls the breathing, ensuring adequate ventilation and gas exchange.

Ventilatory assistance is primarily required in MG during periods of acute respiratory crises or exacerbations, when the weakness of the respiratory muscles becomes critical. Early recognition of respiratory distress, monitoring of vital signs, and judicious use of ventilatory support are essential for the management of patients with MG and the prevention of respiratory failure.