Anticipating Mechanical Ventilation in Guillain-Barré Syndrome

Abstract

While inherently unpredictable, the course of patients with severe GBS can, to some extent, be predicted on the basis of clinical information and simple bedside tests of respiratory function. These data may be used in the decisions regarding admission to the intensive care unit and preparation for elective intubation.

Factors Predicting Extubation Success in Patients with Guillain-Barré Syndrome

“…All patients who met these criteria succeeded extubation, but the mean number of days intubated was long (51 ± 53 days). A delay in extubation can increase the risk of ventilatorrelated complications such as pneumonia, tracheobronchitis, barotrauma, or laryngotracheal stenosis (2,10). On the other hand, premature extubation may lead to the necessity of reestablishing an airway by reintubation, with an associated increase in the risk of ventilatorassociated pneumonia and airway trauma.…”

“…Bulbar dysfunction did not predict patients who failed extubation or who were directly triaged to tracheostomy, although a retrospective analysis may miss this entity because of lack of standardized documentation. The presence of dysarthria or dysphagia has been associated with increased likelihood of mechanical ventilation in patients with GBS (2). LOS in the ICU was significantly increased in patients who failed extubation or were directed to tracheostomy versus patients who successfully extubated.…”

“…Clinical guidelines for intubation have been studied (2,3), but there is a paucity of data identifying markers that predict extubation outcome. In a study of 10 patients, serial vital capacity (VC) measurements were found helpful in determining time for weaning from mechanical ventilation and time for extubation (4).…”

Guillain-Barre Syndrome

“…However, in some instances this criterion may be rather conservative. In a study of 114 consecutive patients with severe GBS admitted to our Neurological ICU, we found that a vital capacity lower than 20 ml/kg, maximal inspiratory pressure lower than 30 cm H 2 0, maximal expiratory pressure lower than 40 cm H 2 O, or a reduction of more than 30% in vital capacity, maximal inspiratory pressure, or maximal expiratory pressure were predictive of progression to mechanical ventilation [35].…”

“…Apart from the respiratory function parameters mentioned before, rapid progression of weakness, bulbar dysfunction and bilateral facial weakness and signs of autonomic dysfunction are additional factors that predict requirement of mechanical ventilation ( Fig. 1) [35]. Therefore, one should have a lower threshold to electively intubate patients that meet these criteria.…”