Prediction models for mechanical ventilation and outcome in Guillain-Barré syndrome

Kumar, Mritunjai; Kalita, Jayantee; Misra, U. K.; Dhar, Nikita

doi:10.1016/j.jocn.2021.07.060

Cited by 7 publications

(9 citation statements)

References 24 publications

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“…Bulbar dysfunction predicted respiratory failure in several studies [4–10, 15–18, 20, 23–27, 33, 36]. Our study confirms bulbar and neck weakness as significant predictors of MV.…”

Section: Discussionsupporting

confidence: 82%

“…Early assessment of respiratory failure is crucial in GBS to prevent mortality and to decide the appropriate patient care. In previous studies, several features have been reported as predictors for the risk of MV, including advanced age, short interval from symptom onset to admission, rapid disease progression, lower cranial nerve weakness, low MRC sum score at nadir, high GBS‐DS scores at entry, dysautonomia, conduction block and/or axonal features on NCS [4, 5, 10, 15, 17–19, 22–27, 32, 33, 43, 44].…”

Section: Discussionmentioning

confidence: 99%

“…Early prediction of respiratory insufficiency is important to correctly triage the patients for appropriate level of care and to prevent complications related to delayed intubation [15][16][17][18][19]. Previous reports [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] identified as predictors of MV facial, bulbar, neck flexor weakness, autonomic dysfunction, low muscle strength at hospital admission, rapid progression, respiratory parameters and presence of conduction block in distal nerves. Furthermore, the Erasmus GBS Respiratory Insufficiency Score (EGRIS) was introduced to predict respiratory insufficiency in the acute stages of the disease.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of respiratory failure in Guillain−Barré syndrome: a 22 year cohort study from a single Italian centre

Galassi,

Mazzoli,

Ariatti

et al. 2023

Euro J of Neurology

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Background and purposeThe study aimed to identify predictors of respiratory failure leading to mechanical ventilation (MV) and tracheostomy in Guillain−Barré syndrome (GBS).MethodsTwo hundred and thirty adult cases admitted to the Neurology Unit of Modena, Italy, between January 2000 and December 2021 were studied. A cut‐off of MV starting within 8 weeks from onset of weakness was used. Univariable, multivariable logistic and Cox regression analyses were used to determine which pre‐specified clinical and diagnostic characteristics were capable of predicting MV and tracheostomy, due to weaning failure. The model was internally validated within the full cohort. The Erasmus GBS Respiratory Insufficiency Score was retrospectively applied.ResultsOne hundred and seventy‐six cases (76.5%) were classified as classical sensorimotor GBS and 54 (23.4%) as variants. Thirty‐two patients (13.9%) needed MV: 84.3% required respiratory support within 7 days. Independent predictors of respiratory failure and MV were older age, facial, bulbar, neck flexor weakness, dysautonomia, axonal electrophysiological subtype, cardiovascular comorbidities and higher disability score at entry. There was no association with abnormal spinal fluid parameters nor with positive serology for recent infections. Twenty‐two patients (68.7%) were ventilated for more than 7 days; 4.7% died within 8 weeks. The patients who required MV were treated more often with plasma exchange. Independent predictors of tracheostomy due to weaning trial failure were facial, bulbar, neck flexor weakness, autonomic dysfunction, associated cardiovascular morbidities and axonal electrophysiological subtype on nerve conduction study.ConclusionsOur study indicates distinct predictors of MV and tracheostomy in GBS patients.

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“…Bulbar dysfunction predicted respiratory failure in several studies [4–10, 15–18, 20, 23–27, 33, 36]. Our study confirms bulbar and neck weakness as significant predictors of MV.…”

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of respiratory failure in Guillain−Barré syndrome: a 22 year cohort study from a single Italian centre

Galassi,

Mazzoli,

Ariatti

et al. 2023

Euro J of Neurology

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“… Question 2: When counseling patients or surrogates of critically ill patients with GBS, should the Sharshar model be considered a reliable predictor of the need for mechanical ventilation within 14 days of disease onset? Description of the predictor : The Sharshar model was developed in 722 patients enrolled in two randomized clinical trials by the French Cooperative Group on Plasma Exchange in GBS [ 44 ] and validated in 92 patients with GBS admitted consecutively to the neurology service of a tertiary care teaching hospital in India [ 92 ]. Sharshar et al identified six clinical variables, including admission within 7 days of onset, inability to lift head and elbows, inability to stand, ineffective cough, and elevated liver enzyme levels.…”

Section: Methodsmentioning

confidence: 99%

“…The body of evidence was further limited by imprecision. The body of evidence on this prognostic model is also insufficient, with only one small validation study reporting calibration results [ 92 ]. Question 3: When counseling patients or surrogates of critically ill patients with GBS, should the Ning Score (MVN) be considered a reliable predictor of the need for mechanical ventilation within 14 days of disease onset?…”

Section: Methodsmentioning

confidence: 99%

Guidelines for Neuroprognostication in Adults with Guillain–Barré Syndrome

et al. 2023

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Background Guillain–Barré syndrome (GBS) often carries a favorable prognosis. Of adult patients with GBS, 10–30% require mechanical ventilation during the acute phase of the disease. After the acute phase, the focus shifts to restoration of motor strength, ambulation, and neurological function, with variable speed and degree of recovery. The objective of these guidelines is to provide recommendations on the reliability of select clinical predictors that serve as the basis of neuroprognostication and provide guidance to clinicians counseling adult patients with GBS and/or their surrogates. Methods A narrative systematic review was completed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Candidate predictors, including clinical variables and prediction models, were selected based on clinical relevance and presence of appropriate body of evidence. The Population/Intervention/Comparator/Outcome/Time frame/Setting (PICOTS) question was framed as follows: “When counseling patients or surrogates of critically ill patients with Guillain–Barré syndrome, should [predictor, with time of assessment if appropriate] be considered a reliable predictor of [outcome, with time frame of assessment]?” Additional full-text screening criteria were used to exclude small and lower quality studies. Following construction of an evidence profile and summary of findings, recommendations were based on four GRADE criteria: quality of evidence, balance of desirable and undesirable consequences, values and preferences, and resource use. In addition, good practice recommendations addressed essential principles of neuroprognostication that could not be framed in PICOTS format. Results Eight candidate clinical variables and six prediction models were selected. A total of 45 articles met our eligibility criteria to guide recommendations. We recommend bulbar weakness (the degree of motor weakness at disease nadir) and the Erasmus GBS Respiratory Insufficiency Score as moderately reliable for prediction of the need for mechanical ventilation. The Erasmus GBS Outcome Score (EGOS) and modified EGOS were identified as moderately reliable predictors of independent ambulation at 3 months and beyond. Good practice recommendations include consideration of both acute and recovery phases of the disease during prognostication, discussion of the possible need for mechanical ventilation and enteral nutrition during counseling, and consideration of the complete clinical condition as opposed to a single variable during prognostication. Conclusions These guidelines provide recommendations on the reliability of predictors of the need for mechanical ventilation, poor functional outcome, and independent ambulation following GBS in the context of counseling patients and/or surrogates and suggest broad principles of neuroprognostication. Few predictors were considered moderately reliable based on the available body of evidence, and higher quality data are needed.

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Challenges and Opportunities with the Clinical–Electrophysiological Prediction of Recovery in Childhood Guillain–Barré Syndrome

Prakash¹,

Sahu²

2022

Indian J Pediatr

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Prediction models for mechanical ventilation and outcome in Guillain-Barré syndrome

Cited by 7 publications

References 24 publications

Predictors of respiratory failure in Guillain−Barré syndrome: a 22 year cohort study from a single Italian centre

Predictors of respiratory failure in Guillain−Barré syndrome: a 22 year cohort study from a single Italian centre

Guidelines for Neuroprognostication in Adults with Guillain–Barré Syndrome

Challenges and Opportunities with the Clinical–Electrophysiological Prediction of Recovery in Childhood Guillain–Barré Syndrome

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