Intubation, tracheostomy, and decannulation in patients with Guillain–Barré–syndrome—does dysphagia matter?

Abstract

Introduction: Although patients with Guillain-Barré syndrome frequently require orotracheal intubation and tracheostomy, the incidence and relevance of neurogenic dysphagia prior to intubation and risk factors for prolonged requirement for a tracheal cannula have not yet been identified. Methods: Retrospective analysis of the medical records of 88 patients was performed. Clinical characteristics were compared between intubated and nonintubated patients and between immediately decannulated and not immediately decannulated patients. Results: Thirty-five (39.7%) patients required tracheostomy. Neuromuscular weakness and related respiratory insufficiency were the main reasons for intubation. In the subgroup of tracheotomized patients, immediate decannulation after completed respiratory weaning was possible in 14 (40%) patients. The severity of dysphagia, in particular pharyngolaryngeal hypesthesia, was related to the length of cannulation. Discussion: Respiratory muscle weakness is the main reason for intubation, whereas neurogenic dysphagia is the main risk factor for persisting cannulation. Dysphagia after weaning is most frequently characterized by severe laryngeal sensory deficit.

Autoimmunity complicating SARS-CoV-2 infection in selective IgA-deficiency

“…5 We have not observed ophthalmoplegia, yet dysphagia subsequent to bulbar palsy resulted in necessity for tracheostomy in our patient as described before. 7 Finally, our findings expand the spectrum of autoimmunity after COVID-19. Although COVID-19 was repeatedly demonstrated as an inducer of GBS alone, we believe that the preexisting sIgAD significantly contributed to the development of 2 different autoimmune disorders after COVID-19.…”

“…5 We have not observed ophthalmoplegia, yet dysphagia subsequent to bulbar palsy resulted in necessity for tracheostomy in our patient as described before. 7 …”

Therapy-resistant dysphagia successfully treated using pharyngeal electrical stimulation in a patient with the pharyngeal-cervical-brachial variant of the Guillain-Barré syndrome

“…Dysphagia can be associated with numerous neuromuscular diseases and present different mechanisms, such as loss of motor neurons, damage to caudal brain nerves (neuropathies or local nerve lesions), neuromuscular transmission or musculoskeletal disorders [ 1 ]. In inflammatory neuropathies, such as Guillain-Barré syndrome (GBS) and variants, dysphagia is rare but increasingly described in the literature, with severe cases requiring intensive care treatment [ [2] , [3] , [4] ]. GBS is an immune-mediated polyneuropathy characterized by rapidly progressive weakness and sensory loss.…”

Laringotraqueoscopia Flexível Na Decanulação De Pacientes Traqueostomizados: Otimização De Segurança Para O Paciente

“…Cerca de 10% dos pacientes que necessitam de ventilação mecânica, no período entre 7 a 14 dias ao final são traqueostomizados para manutenção de ventilação mecânica prolongada ou suporte de vias aéreas. 1,2,3 Sabe-se que a permanência prolongada do tubo orotraqueal é fator causador de complicações anatomofisiológicas laringotraqueais e potencial gerador de sequelas graves em via aérea. 4 As alterações laríngeas agudas são diagnósticas em até 94% dos pacientes, desde um processo inflamatório traqueal à estenose complexa.…”

“…5,6 Outra indicação da traqueostomia é a obtenção de via aérea segura nos pacientes com risco de obstrução das vias aéreas superiores, sobretudo por processos infecciosos cervicais profundos, tumores, corpo estranho, angioedema, disfunção de pregas vocais e edema glótico após intubação orotraqueal. 2,7,8 A cânula de traqueostomia, no entanto, apresenta-se como corpo estranho e pode causar complicações tais como broncorreia excessiva ou tosse; alteração do mecanismo fisiológico de proteção contra a broncoaspiração; diminuição da eficácia da tosse ; infecção; sangramento; dificuldade de vocalização, o que, além de provocar alterações laríngeas como hipotonia, contribui para o isolamento social do paciente. 4,9,10 Em pacientes que utilizam cânula de traqueostomia, a alteração do processo fisiológico impedindo que o ar não passe pela cavidade nasofaríngea entrando diretamente a árvore traqueobrônquica prejudica todo sistema de umidificação do ar.…”