Comparison of ICU Outcomes between Intravenous Immunoglobulin and Plasma Exchange in Treatment of Mechanically Ventilated Patients with GuillainBarré Syndrome in a Neuro-Intensive Care Unit in a Govt. Hospital of Bangladesh: A Observational Cohort Study

Abstract

Background: The management of Guillain-Barré Syndrome is very crucial for the outcome of the patient.
 Objective: The aim of the study was to compare efficacy of IvIg(Intravenous Immunoglobulin) versus PE(Plasmaexchange) in treatment of mechanically ventilation adults with GBS in neuro-intensive care unit of Bangladesh.
 Methodology: Thiswas a prospective, observationalcohort study, in a Neuro-ICU from 2017 to 2018. We included all patients with GBS who required mechanical ventilation (MV). We defined two groups: group 1 (group treated by IvIg: 0.4 g/kg/day for 5 days) and group 2 (group treated by PE: 5 PE during 10days, every alternate day). We collectedclinical and therapeutic aspects and outcome.
 Results: A total number of 49 patients (34 in group 1 and 15 in group 2) were enrolled. The mean age was 37.4±9.2 years, with a male predominance (65.3%). on electrophysiological findings, in 4(32.7%) patients had acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and acute motor axonal neuropathy (AMAN) in 26 (53.1%) patients and acute motor-sensory axonal neuropathy (AMSAN) was 3(6.1%)and NCS was not done in 4(8.2%) cases. The mean length of ICU stay was 20±19.10 days and 46.60±30.02 days in IVIG and PE group respectively. The ICU stay was significantly shorter (p = 0.001) in the IvIg group than PE group. Patients receiving IvIg were early weaned of MV (p = 0.002) compared to those receiving PE with a statistical significance. Also, duration of M/V (P=.002), Need of tracheostomy (p=.005) and over all surval rate (p=.007) was significantly in favoue of IvIg group than PE group. Out of 49 patients, total 3 patients were died and they all were AMAN variety.
 Conclusion: Our work reveals a meaningful difference for the MV duration, ICU stay, weaning and excellent recovery in IvIg group compared to PE group in terms of less complcations.
 Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 118-122

Plasma exchange (PE) versus intravenous immunoglobulin (IVIG) for the treatment of Guillain-Barré syndrome (GBS) in patients with severe symptoms: A systematic review and meta-analysis

“…Moreover, we found that the time until discontinuation from MV was similar in both IVIG and PE groups. The finding is contradicted by Mallick and colleagues, who reported that the patients treated with IVIG were weaned from MV earlier than the patients treated with PE ( p = 0.002) [ 26 ]. However, the results of that study cannot be used to guide clinical treatment with IVIG since the study included a small number of patients and was designed as an observational study with poor methodological quality.…”

“…Our analysis did not demonstrate any significant difference in complication rates between patients receiving IVIG and PE. However, one study which led to significant differences in the analysis was eliminated because we could not tell whether these complications were a result of the mechanical ventilation or the treatments used for GBS [ 26 ].…”

Patterns of Clinical Presentation and In-Hospital Outcome of Adult Patient with Guillain-Barre Syndrome

“…The outcome of GBS varies from spontaneous recovery to wheelchair dependency to death. Case fatality rate and poor outcome is lower in high-income countries in comparison to low-income country [8]. But there were few studies regarding in-hospital outcome and predictors of poor in-hospital outcome.…”

Treatment Efficacy of Plasmapheresis Versus Intravenous Immunoglobulin in Guillain-Barré Syndrome Management: A Systematic Review

“…Mallick et al and Saad et al reported that patients treated with PE had lowered hospitalization costs due to far shorter ICU stays and shorter periods of MV than patients treated with IVIG[18,16].Beydoun et al …”