Intraoperative use of BiPAP in patients with severe acute exacerbation of COPD and myasthenia gravis

Abstract

Introduction: severe acute exacerbation of chronic obstructive pulmonary disease is the sixth leading cause of death worldwide and its association with myasthenia is exceptional. When both conditions coexist in a patient requiring emergency surgery, it poses a challenge due to anesthetic difficulty in maintaining ventilation and the need for early extubation. In such situations, the use of BiPAP improves the ventilatory parameters and increases the safety margin for barotrauma, as well as it theoretically allows reducing the ventilation period.
Objective: To show the ventilatory behavior in a clinical case with chronic obstructive pulmonary disease and myasthenia gravis accepted for transversostomy.
Clinical case: A patient admitted to the intensive care unit for severe acute exacerbation of COPD associated with cholinergic crisis presented a bladder and rectal fistula and was intervened as an emergency for a transversostomy. Preoperative assessment made by the anesthesiologists is described, together with the blood gas and imaging studies. The preanesthetic medication is presented, together with the action plan developed with special emphasis on the application of intraoperative BiPAP.
Conclusions: This ventilatory mode can be an efficient choice in the intraoperative time for patients at high risk for postoperative respiratory complications.