ICU · neurocritical-care
Myasthenia Gravis Crisis — Comprehensive ICU Management
Also known as Myasthenic crisis · Myasthenia gravis exacerbation · Cholinergic crisis · Neuromuscular respiratory failure · AChR myasthenia gravis · MuSK myasthenia gravis · Acetylcholine receptor antibody disease · Fatigable weakness · Plasmapheresis for myasthenia · IVIG for myasthenia
Comprehensive ICU management of myasthenic crisis — consensus definitions of impending and manifest crisis, precipitants and ICU risk factors, NIV before hypercapnia, intubation and extubation predictors, PLEX or IVIg with comorbidity-based choice, corticosteroid timing, MuSK-MG, and long-term therapy (thymectomy, rituximab, eculizumab).
Checked against its sources on 8 Oct 2026
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Red flags
- Manifest crisis is worsening weakness requiring intubation or NIV to avoid intubation — manage in ICU or step-down
- PCO2 over 45 mmHg at BiPAP initiation predicted BiPAP failure — start NIV before hypercapnia
- Pronounced bulbar weakness may necessitate intubation to prevent upper airway obstruction
- PLEX cannot be used in sepsis; IVIg is contraindicated in renal failure, hypercoagulable states or immunoglobulin hypersensitivity
- Corticosteroids may transiently worsen weakness — consider waiting for PLEX or IVIg to work first
Meet the patient
A 62-year-old man with AChR-antibody MG and a known thymoma presents after a week of a chest infection with dysphagia, a fading voice and breathlessness; his cough is weak and he is pooling secretions. The questions are whether she is heading for the tube, and what triggered the crisis — most patients presenting with crisis have an identifiable risk factor.[15][4]
References23ShowHide
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