Mechanical Ventilation in Guillain-Barré Syndrome: Does Age Influence Functional Outcome?

Abstract

Purpose: To examine the effects of age on differences in the clinical course and functional outcome of mechanically ventilated Guillain-Barré syndrome (GBS) patients. Methods: 32 consecutive patients with GBS in need of mechanical ventilation were divided into two groups: (1) 15 patients <65 years, and (2) 17 patients ≥65 years. Length of ventilation, therapy, incidence of bulbar involvement, dysautonomia, preceding infections, need for tracheostomy, mortality, and functional outcome at 1-year follow-up using the Hughes outcome scale were analyzed. Results: The groups were comparable regarding treatment, lesion type, incidence of bulbar involvement, dysautonomia, preceding infections and duration of ventilation. The majority of patients (75%) received combination therapy (intravenous immunoglobulin and plasma exchange). Tracheostomy was performed in 91% of patients. Mortality was higher in older patients (41 vs. 7%; p = 0.02) and overall outcome worse (p = 0.05). Interestingly, once surviving the early, most critical period, older patients functionally recovered as well as younger patients (80% good outcome vs. 86%; p = 0.71). Conclusions: Despite all the advances in intensive care, mortality in older, ventilated GBS patients is still substantial. However, once they have survived the early, most critical period, older patients may recover as well as younger patients. Special care should therefore be taken to prevent and, if present, to vigorously treat complications commonly associated with intensive care treatment of severe GBS in elderly patients.

Predictors for good functional outcome after neurocritical care

“…Hence, neurological syndromes due to neurovascular and inflammatory causes, which represent the majority in this study and result in the necessity of intensive care only show a limited capacity of complete recovery, whereas diseases without affection of neurons, that is, due to autoimmune causes, recovery may not be limited [6]. Nonetheless, specialized neurocritical care is justified as a number of specific treatment regimens have emerged over the past years.…”

Comparison of efficacy and outcome of intravenous immunoglobulin therapy versus plasmapheresis in patients with Gullian Barre syndrome

“…8 Kohrmann M et al in their study reported incidence of intubation and mechanical ventilation to 81.25% when they studied 32 patients of GBS. 9 In our study the incidence of intubation and mechanical ventilation was 29.41%. GBS being a purely neurological disease, the complications associated with it are related to mechanical ventilation.…”

“…Martin Kohrmann et al in their study reported incidence of intubation and mechanical ventilation to 81.25% when they studied 32 patients of GBS. 8,9 In our study of 34 patients 10 patients required intubation, that is 29.6%. This may be because of small sample size or may indicate need for more conservative protocols for intubation in GBS patients.…”

“…15 Kohrmann M et al reported 56%incidence of dysautonomia in their study with 75% of mortality amongst those patients with dysautonomia. 9 Infection is probably the most common medical complication that develops in GBS patients in the ICU. The major sources of infection are the lungs, urinary tract, and central intravenous catheters.…”

Immune Mediated Diseases and Immune Modulation in the Neurocritical Care Unit

“…Despite improvement in ICU care and advances in immunotherapy, the mortality in patients with AIDP/GBS are still at least 2 to 3%, and may even approach 10% [88,[101][102][103]. Advanced age and the presence of medical comorbidities are the most potent predictors of poor outcome [104][105][106].…”