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: |
Declines in serial measures of VC below 15 to 20 mL/kg ideal body weight |
Declines in serial measurements of MIP less negative than -25 to -30 cmH2O (ie, 0 to -30 cmH2O) |
Clinical signs of respiratory distress |
Evidence of progressive respiratory acidosis |
Difficulty handling oral secretions |
Withdraw anticholinesterase medications 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 plasma exchange or IVIG treatment, 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 |