Many  Intensivists   straight  away intubate  and  mechanically  Ventilate the  patients.  In  my  personal  experience  > 100  instances majority  of  the  patients  in  Myasthenic  crisis  recover  completely  with Inj. Neostigmin  Slow  IV  bolus upto  1 to 1.5 mg over  5  minutes  period  without  intubation. Soon they  needed  IM  Neostigmin  with  oral  Pyridostigmin. Some  of  these  patients  also  received IV Ig. Rarely 2 - 3 % crisis  patients  needed intubation  and Mechanical  Ventilation

Do Patients in Myasthenic Crisis require direct Mechanical Ventilation ? - ResearchGate. Available from: https://www.researchgate.net/post/Do_Patients_in_Myasthenic_Crisis_require_direct_Mechanical_Ventilation [accessed Jun 16, 2016].

It's interesting your observation. Your percentage of mechanical ventilation is very  low. .Another difference is that in our hospital all  the patients in Myasthenic crisis  received IVIg.

In developing countries , ventilators may not be easily available to treat myasthenic crisis . Therefore , Neostigmine is a valuable drug to treat this complication . In addition , a similar complication due neurotoxic cobra snake bite envenomation can be treated similarly . This is very useful in rural areas & has been included in the protocol of treatment of snake bite. 

Sometimes, not always.

Depends on response to drug therapy and co-morbid condition/s.

-Parimal

I had two nieces die of an atypical form of Myasthenia Gravis.  One of them died within a few days of life with an unknown diagnosis.  The next one had a cardiac arrest at three days of life and required mechanical ventilation, but subsequently died at about 17 months of life from co-morbidities.

In my humble opinion, based on limited experience, mechanical ventilation may not only be of limited availability, it also always carries a significant probability of ventilator associated complications.  Therefore, neostigmine treatment should be tried before subjecting the patient to ventilation.

In my limited experience, all of them diagnosed patients of Myasthenia Gravis even on oral Pyridostigmin at one point of time go in to Myasthenic crisis.  At that point sometimes you donot have time for IV Neostigmin to act and tide over the crisis, therefore it is better to intubate and ventilate for some hours or couple of days with concomitant. medications ( Neostigmin followed by Pyridostigmin). By this time the crisis is over and patient can be safely extubated  minimising the chances of ventilator associated infection.

я думаю, что критерием перевода на ИВЛ больного с миастеническим кризом является невозможность адекватной работы дыхательных мышц и как следствие этого нарастающая гипоксемия (РаО2 в артерии меньше 60мм рт ст)

depends on patient response to therapy and Age, gender, duration of illness, baseline symptoms and co-morbid conditions

Agreed with all the above statements. I frequently tell my fellows and residents that when in doubt please intubate.  A high clinical suspicion it is a must in management this debilitating and chronically fatal condition.