COVID-19 patients in myasthenic crisis managed successfully with noninvasive positive pressure ventilation: a case series.

The management of respiratory failure during the present pandemic has been a challenging issue for the intensivists. There have been few case series and case reports on myasthenic crisis precipitated by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. The combination of coronavirus disease-19 (COVID-19) pneumonia and myasthenic crisis can result in increased morbidity and mortality if not managed efficiently. The choice of ventilation ranges from non-invasive to invasive. However a lack of proper understanding of pathophysiology of myasthenia gravis and also the COVID-19 could make the decision of selecting the modality of ventilation a real difficult one. Although invasive ventilation is traditionally indicated when the myasthenia gravis patient presents in myasthenic crisis, there is emerging evidence for use of non-invasive ventilation with BiPAP mode in these patients. We present two cases of myasthenic crisis precipitated by SARS-CoV-2 which were successfully managed on non-invasive ventilation, thereby avoiding intubation and complications of invasive mechanical ventilation.