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All Journal Jurnal MedScientiae Jurnal Kedokteran Meditek
Octavia, Eva
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Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Penatalaksanaan Gagal Napas pada Poliautoimun Multipel Sklerosis dengan Krisis Miastenia Octavia, Eva; Halimi, Radian Ahmad; Sitio, Nurita Dian Kestriani Saragi
Jurnal Kedokteran Meditek Vol 31 No 6 (2025): NOVEMBER
Publisher : Fakultas Kedokteran Universitas Kristen Krida Wacana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36452/jkdoktmeditek.v31i6.4000

Abstract

Introduction: Polyautoimmune involving multiple sclerosis (MS) and myasthenia gravis (MG) is rare, with overlapping clinical manifestations due to shared immunopathogenic mechanisms. The main challenge in such patients is the high risk of ventilator weaning failure, especially when complicated by ventilator-associated pneumonia (VAP). This report highlights the rarely reported success of ventilator weaning through a multidisciplinary and comprehensive management approach in MS-MG polyautoimmunity. Case Illustration: A 39-year-old female with relapsing-remitting MS and MG developed a myasthenic crisis requiring mechanical ventilation. Therapeutic plasma exchange (TPE) was initiated on the second day of treatment and continued for five cycles. Ventilator weaning was performed gradually in accordance with clinical improvement, but was hindered by VAP, necessitating tracheostomy. High-protein enteral nutrition support and early mobilization were initiated on the second day of treatment. After 24 days of intensive care, the patient was successfully weaned from the ventilator with stable respiratory function and improved muscle strength. She was discharged ten days later with tracheostomy care instructions and was able to perform independent active mobilization. Discussion: MS-MG polyautoimmunity presents complex immunological mechanisms that require a multidisciplinary approach. Evidence-based comprehensive management that integrates immunomodulatory therapy, treatment of VAP complications, high-protein enteral nutrition, mobilization, and progressive pulmonary rehabilitation significantly improved respiratory function and accelerated weaning from the ventilator. Conclusion: An evidence-based, comprehensive approach through multidisciplinary collaboration can enhance ventilator weaning and improve clinical outcomes and quality of life in patients with MS-MG polyautoimmunity.  
Manajemen Gagal Napas Akut pada Pasien Sindrom Obstruksi Pasca-Tuberkulosis Octavia, Eva
Jurnal MedScientiae Vol 5 No 2 (2026): August
Publisher : Universitas Kristen Krida Wacana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36452/jmedscientiae.v5i2.4370

Abstract

PTLD causes persistent structural lung damage and reduced respiratory reserve, increasing the risk of acute respiratory failure during pulmonary infection. No specific protocol exists for escalation of respiratory support or ventilator weaning in PTLD. A 27-year-old woman with previously treated pulmonary TB presented with progressive dyspnea, increasing WOB, and hypoxemia. Chest imaging showed fibrosis, consolidation, atelectasis, and right lung volume loss, while microbiological testing for TB was negative. HFNC increased oxygen saturation to 100%, but respiratory distress persisted and consciousness deteriorated, prompting intubation and invasive mechanical ventilation. The patient received ventilator support, empiric antibiotics, progressive nutritional and early mobilization support, and weaning using an extensive SBT strategy as tolerated. She was successfully extubated on day four and discharged after 13 days without supplemental oxygen, independent in daily activities, and gaining weight. Normal oxygen saturation during oxygen therapy does not necessarily indicate adequate ventilation/reduced respiratory load and may conceal a risk of P-SILI. Timely intubation, tolerance-based weaning, and early integration of nutritional and mobilization supported respiratory recovery and successful extubation. Therefore, management of acute respiratory failure in PTLD should rely on comprehensive assessment beyond oxygen saturation and an individualized multidisciplinary approach.
Co-Authors Radian Ahmad Halimi Sitio, Nurita Dian Kestriani Saragi