Predictive Factors and Long-Term Outcome of Respiratory Failure after Guillain-Barré Syndrome

Cheng, Ben-Chung; Chen, Jin‐Bor; Tsai, Chien-Yu; Hsu, Kuo-Tai; Chang, Wen-Neng; Chang, Chen-Sheng; Tsai, Nai‐Wen; Lu, Cheng-Hsien; Chang, Chin-Jung; Hung, Po-Cheng; Wang, Kuo-Wei; Chang, Hsueh‐Wen

doi:10.1097/00000441-200406000-00007

Cited by 36 publications

(37 citation statements)

References 24 publications

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“…As previously shown, weaning should be undertaken as early as possible [23]. The observed median ventilation time of 19 days in our study was on the shorter side of previously reported studies for ventilated GBS patients [6, 12, 13, 22, 24]. Possible explanations for this are the aggressive approach of an early tracheostomy and the fact that, contrary to previous studies, all patients received either PE and/or IVIg treatment, with the majority receiving a sequential combination of the two during the course of the disease.…”

Section: Discussionsupporting

confidence: 54%

“…Information on the prognosis of a given disease in this patient group is needed not only for medical reasons, but also for economic considerations, resource allocation and most importantly in order to inform patients and relatives. Mortality has been shown to be significantly higher in elderly ICU patients [8, 20], but only little information is available on long-term prognosis, quality of life, and functional recovery of surviving elderly patients in general [11, 20] and particularly for less common diseases like GBS [12, 13]. The aim of this study was to examine the age-dependent differences in the course of severe GBS requiring mechanical ventilation and whether older patients functionally recover as well as young patients once they survive intensive care management.…”

Section: Discussionmentioning

confidence: 99%

“…Short-term studies focusing only on the initial ICU stay may suggest an overly optimistic prognosis since early post-hospital mortality is substantial in those patients [9, 10]. Functional outcome of surviving elderly ICU patients has not been studied as well [11], particularly for less common diseases such as GBS [12, 13]. Therefore, we set out to study the effect of age on the course of the disease and on the long-term functional outcome of ventilated GBS patients.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2009

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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.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2009

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“…Several studies have demonstrated that the measurement of respiratory muscle force by means of MIP and MEP may be very useful in the diagnosis and follow-up of pulmonary and cardiac diseases [2,3], as well as in patients affected with myasthenia gravis [4] or Guillain-Barré syndrome [5].…”

Section: Discussionmentioning

confidence: 99%

“…Although this test has possible limitations mainly due to no cooperation or noncompliance, several studies have demonstrated that MIP and MEP may be very useful in the diagnosis and follow-up of pulmonary and cardiac disease [2,3]. A reduction in MIP has been shown to be associated with a progressive clinical worsening in patients affected with myasthenia gravis [4] or Guillain-Barré syndrome [5]. In addition, it has been suggested that an imbalance between the pressure generated by the inspiratory muscles and the MIP may lead to the development of hypercapnia in patients with chronic obstructive pulmonary diseases (COPD) [6].…”

mentioning

confidence: 99%

Maximal inspiratory and expiratory pressure measurement in tracheotomised patients

et al. 2006

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The present study compared four different sites and conditions for the measurement of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) in 38 spontaneous breathing tracheotomised patients. Of the patients, 28 had chronic obstructive pulmonary disease (COPD).The four different conditions were: 1) through a cuff inflated cannula (condition A); 2) through the mouth with a deflated cannula (condition B); 3) through the mouth with a phonetic uncuffed cannula (condition C); and 4) through the mouth after stoma closure (condition D). Five trials in each condition were performed using a standardised method.The measurement of both MIP and MEP differed significantly depending on the condition of measurement. MIP taken in condition A was significantly higher when compared with conditions B, C and D. MEP in condition A was significantly higher when compared with condition B and D. In condition A the highest frequency of the best measurement of MIP and MEP was observed at the fourth and fifth effort, respectively. The same results were obtained after the selection of only COPD patients.In conclusion, respiratory muscle assessment differs significantly depending on measurement condition. Measurement through inflated cannula tracheotomy yields higher values of both maximal inspiratory and maximal expiratory pressure.

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Causes and Outcomes of Acute Neuromuscular Respiratory Failure

Cabrera‐Serrano¹,

Rabinstein²

2010

Arch Neurol

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To identify the spectrum of causes, analyze the usefulness of diagnostic tests, and recognize prognostic factors in patients with acute neuromuscular respiratory failure.Methods: We evaluated 85 patients admitted to the intensive care unit (ICU) at Mayo Clinic, Rochester, between 2003 and 2009 with acute neuromuscular respiratory failure, defined as a need for mechanical ventilation owing to primary impairment of the peripheral nervous system. Outcome was assessed at hospital discharge and at last follow-up. Poor outcome was defined as a modified Rankin score greater than 3. Results:The median age was 66 years; median followup, 5 months. The most frequent diagnoses were myasthenia gravis, Guillain-Barré syndrome, myopathies, and amyotrophic lateral sclerosis (27, 12, 12, and 12 patients, respectively). Forty-seven patients (55%) had no known neuromuscular diagnosis before admission, and 36 of them (77%) had poor short-term outcomes. In 10 patients (12%), the diagnosis remained unknown on dis-

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Predictive Factors and Long-Term Outcome of Respiratory Failure after Guillain-Barré Syndrome

Cited by 36 publications

References 24 publications

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

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

Maximal inspiratory and expiratory pressure measurement in tracheotomised patients

Causes and Outcomes of Acute Neuromuscular Respiratory Failure

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