Mechanical ventilation in Guillain–Barré syndrome

Shang, Pei; Zhu, Mingqin; Baker, Matthew; Feng, Jiachun; Zhou, Chunkui; Zhang, Hong‐Liang

doi:10.1080/1744666x.2021.1840355

Cited by 32 publications

(35 citation statements)

References 84 publications

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“…The disease course is frequently severe with high rates of respiratory dysfunction and ICU admission. 96 The time elapsed between infection and neurologic manifestations, and a negative PCR in spinal fluid might suggest that there is a postinfectious mechanism implicated in the etiology of COVID-19-related GBS. However, these results should be interpreted with caution as the cases included in this systematic review varied widely in diagnostic ascertainment and reporting of different variables.…”

Section: Discussionmentioning

confidence: 99%

Guillain Barre Syndrome as a Complication of COVID-19: A Systematic Review

Aladawi

Elfil

Abu-Esheh

et al. 2021

Can. J. Neurol. Sci.

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Background: In January 2020, the first case of Guillain Barre syndrome (GBS) due to COVID-19 was documented in China. GBS is known to be postinfectious following several types of infections. Although causality can only be proven through large epidemiological studies, we intended to study this association by a thorough review of the literature. Methods: We searched PubMed, EMBASE, and Google scholar and included all papers with English or Spanish full text and original data of patients with GBS and recent COVID infection. Variables of interest were demographics, diagnostic investigations, and the latency between arboviral and neurological symptoms. Further variables were pooled to identify GBS clinical and electrophysiological variants, used treatments, and outcomes. The certainty of GBS diagnosis was verified using Brighton criteria. Results: We identified a total of 109 GBS cases. Ninety-nine cases had confirmed COVID-19 infection with an average age of 56.07 years. The average latency period between the arboviral symptoms and neurologic manifestations for confirmed COVID-19 cases was 12.2 d. The predominant GBS clinical and electromyography variants were the classical sensorimotor GBS and acute demyelinating polyneuropathy respectively. Forty cases required intensive care, 33 cases required mechanical ventilation, and 6 cases were complicated by death. Conclusions: Studies on COVID-19-related GBS commonly reported sensorimotor demyelinating GBS with frequent facial palsy. The time between the onset of infectious and neurological symptoms suggests a postinfectious mechanism. Early diagnosis of GBS in COVID-19 patients is important as it might be associated with a severe disease course requiring intensive care and mechanical ventilation.

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Section: Discussionmentioning

confidence: 99%

Guillain Barre Syndrome as a Complication of COVID-19: A Systematic Review

Aladawi

Elfil

Abu-Esheh

et al. 2021

Can. J. Neurol. Sci.

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“…The key issues implicated in the initiation of MV, the configuration parameters of ventilators, and the decision on tracheostomy, etc . have been extensively reviewed elsewhere ( Shang et al, 2020b ). In practice, MV needs to be considered when one or two of following criteria are met: (a) vital capacity <15 ml/kg BW, (b) hypoxemia (PaO 2 < 7.5 kPa), (c) hypercarbia (PaCO 2 > 6.4 kPa), and (d) intolerable respiratory distress ( Burakgazi and Hoke, 2010 ) ( Figure 4 ).…”

Section: Canonical and Emerging Immunotherapies Of Guillain–barré Syndromementioning

confidence: 99%

“…Individualized monitoring of VC, respiratory rate and pressure, and oxygen saturation is emphasized in patients with severe GBS, especially for those with rapidly progressive paralysis ( Chevrolet and Deleamont, 1991 ; Shang et al, 2020b ). In all possibilities, MV should be initiated stepwise and individually based on patients’ oxygen saturation and respiratory efforts.…”

Section: Canonical and Emerging Immunotherapies Of Guillain–barré Syndromementioning

confidence: 99%

Intensive Care and Treatment of Severe Guillain–Barré Syndrome

Shang

Feng

et al. 2021

Front. Pharmacol.

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Guillain–Barré syndrome (GBS) is an acute polyneuropathy mostly characterized by acute flaccid paralysis with or without sensory/autonomous nerve dysfunction. Current immuno therapies including intravenous immunoglobulin (IVIg), plasma exchange (PE), and newly developed biological drugs benefit patients by alleviating hyperreactive immune responses. Up to 30% of patients develop respiratory failure during hospitalization and require mechanical ventilation and intensive care. Immunotherapies, mechanical ventilation, supportive care, and complication management during the intensive care unit (ICU) stay are equally emphasized. The most important aspect of intensive care and treatment of severe GBS, that is, mechanical ventilation, has been extensively reviewed elsewhere. In contrast to immunotherapies, care and treatment of GBS in the ICU setting are largely empirical. In this review, we intend to stress the importance of intensive care and treatment, other than mechanical ventilation in patients with severe GBS. We summarize the up-to-date knowledge of pharmacological therapies and ICU management of patients with severe GBS. We aim to answer some key clinical questions related to the management of severe GBS patients including but not limited to: Is IVIg better than PE or vice versa? Whether combinations of immune therapies benefit more? How about the emerging therapies promising for GBS? When to perform tracheal intubation or tracheostomy? How to provide multidisciplinary supportive care for severe cases? How to avert life-threatening complications in severe cases?

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“…Although many predictive indices and clinical tools are already in use [1,[13][14][15][16][17][18][19][20][21][22], >20% of the patients who have fulfilled the classic weaning criteria require reintubation [14,[23][24][25]. The predictive performance decreases in patients with multi-organ dysfunction, older age, prolonged MV, and severe illness [26][27][28][29][30][31]. The lack of reliable weaning parameters is related to the heterogeneity of critically ill patients and their ever-changing clinical courses [32][33][34][35].…”

Section: Introductionmentioning

confidence: 99%

Biosignal-Based Digital Biomarkers for Prediction of Ventilator Weaning Success

Park

Kim

Jung

et al. 2021

IJERPH

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We evaluated new features from biosignals comprising diverse physiological response information to predict the outcome of weaning from mechanical ventilation (MV). We enrolled 89 patients who were candidates for weaning from MV in the intensive care unit and collected continuous biosignal data: electrocardiogram (ECG), respiratory impedance, photoplethysmogram (PPG), arterial blood pressure, and ventilator parameters during a spontaneous breathing trial (SBT). We compared the collected biosignal data’s variability between patients who successfully discontinued MV (n = 67) and patients who did not (n = 22). To evaluate the usefulness of the identified factors for predicting weaning success, we developed a machine learning model and evaluated its performance by bootstrapping. The following markers were different between the weaning success and failure groups: the ratio of standard deviations between the short-term and long-term heart rate variability in a Poincaré plot, sample entropy of ECG and PPG, α values of ECG, and respiratory impedance in the detrended fluctuation analysis. The area under the receiver operating characteristic curve of the model was 0.81 (95% confidence interval: 0.70–0.92). This combination of the biosignal data-based markers obtained during SBTs provides a promising tool to assist clinicians in determining the optimal extubation time.

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Mechanical ventilation in Guillain–Barré syndrome

Cited by 32 publications

References 84 publications

Guillain Barre Syndrome as a Complication of COVID-19: A Systematic Review

Guillain Barre Syndrome as a Complication of COVID-19: A Systematic Review

Intensive Care and Treatment of Severe Guillain–Barré Syndrome

Biosignal-Based Digital Biomarkers for Prediction of Ventilator Weaning Success

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