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Background  Maximal inspiratory pressure (MIP) is used to assess respiratory muscle strength of patients with myasthenia gravis (MG) requiring ventilatory support. Electrical activity of the diaphragm (E-di) has been used to guide weaning.    Case presentation  The MIP and tidal volume/ΔE-di (the patient-to-ventilator breath contribution) were monitored in a 12-year-old girl with MG requiring ventilator support. The same ventilatory settings were maintained until extubation. During weaning, MIP increased slightly, but varied unpredictably. Tidal volume/ΔE-di decreased at a constant rate as muscle strength recovered.    Conclusion  In this patient with muscle weakness, E-di was a reliable tool to monitor weaning from mechanical ventilation.

Monitoring diaphragm function in a patient with myasthenia gravis: electrical activity of the diaphragm vs. maximal inspiratory pressure