Difficult weaning approach leading to diagnosis of myasthenia gravis

Fabricio Ortiz-Larios; Edward Darielle Domínguez-González; Yessica García-Salas

2025, Number 1

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Med Crit 2025; 39 (1)

Difficult weaning approach leading to diagnosis of myasthenia gravis

Ortiz-Larios F, Domínguez-González ED, García-Salas Y

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How to cite this article

10.35366/121122

Language: Spanish
References: 20
Page: 61-66
PDF size: 324.29 Kb.

ABSTRACT

Introduction: failure to wean from mechanical ventilation is due to multiple etiologies, such as pulmonary, cardiac, neuromuscular dysfunction, among others. Each one requires a systematized analysis for its identification and timely correction, with the objective of trying again to wean the patient from mechanical ventilator. Case report: 49-year-old woman, who ingested multiple tablets of Lorazepam, was intubated due to unconsciousness. Flumazenil test was performed upon admission with immediate awakening, but failed two extubation attempts despite successful spontaneous breathing trials. The diagnostic approach documented myasthenia gravis as the main etiology. She was offered treatment and subsequently achieved successful extubation. Conclusions: this clinical case exemplifies the importance of a systematic approach to find the cause of extubation failure and not only to solve the complication. This allowed us to offer the appropriate treatment and achieve successful extubation.

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