Admit to intensive care unit |
Measure VC frequently, as often as every two hours if respiratory status is deteriorating |
Consider elective intubation based upon overall clinical status, particularly in the presence of any of the following conditions:
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Withdraw anticholinesterase medications temporarily to avoid excess airway secretions for patients who are intubated |
Seek and treat any precipitating or contributing factors, particularly infections |
Begin rapid therapy with plasma exchange or IVIG |
Begin immunomodulating therapy with high-dose glucocorticoids (eg, prednisone 60 to 80 mg per day); consider azathioprine, mycophenolate mofetil, or cyclosporine if glucocorticoids are contraindicated or previously ineffective |
After starting immunomodulating therapy and resuming anticholinesterase medications, consider weaning from mechanical ventilation when respiratory muscle strength is improving (ie, VC >15 to 20 mL/kg and MIP more negative than –25 to –30 cmH2O) in patients with an adequate cough and manageable respiratory secretions |
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