Iraqi Journal of Medical Sciences








Vol. 12 Issue 3 July - September / 2014
Published on website | Date : 2016-03-24 10:09:02

CLINICAL AND PARACLINICAL PREDICTORS OF MECHANICAL VENTILATION IN GUILLAIN BARRÉ SYNDROME

Zaki N. Hasan, Sajid I. Kadhim, Aqeel K. Hatim, Ghufran K. Shamick


Abstract

Background: Guillain Barré syndrome (GBS) is an acute post infective autoimmune polyradiculo-neuropathy; it is the commonest polyneuropathy causing respiratory failure. A lot of studies suggested certain GBS clinical and preclinical features anticipate and predicate the neuromuscular respiratory failure and can accurately assess the progression to mechanical ventilation; bulbar muscles involvement, severity of weakness of upper and lower limbs, bilateral facial muscles involvement and autonomic nervous system involvement were the main features associated with progression to mechanical ventilation.
Objectives:To assess demographic, clinical and para clinical features and their relation with the progression of GBS to respiratory failure.
Methods: Clinical and paraclinical predictors of impending respiratory involvement and requirement for mechanical ventilation were studied in 40 GBS patients aged 12-57 years (28 males and 12 females).
Results:Ten (6 female/4 male) patients (25%) were admitted to the intensive care unit and received mechanical ventilation. Younger age, female gender and rapid disease progression in first 3 days were associated with respiratory involvement and subsequent ventilation. Bulbar weakness, bilateral facial palsy, poor digit counting (<10/1 breath) were the strongest indicators of impending respiratory failure. In combination they were found in 90% of ventilated patients. Dense weakness (power grade ≤2), weak neck flexion and axonal electromyography also showed significant risk for mechanical ventilation. Other parameters (autonomic dysfunction, antecedent gastrointestinal and respiratory illness, earlier upper limbs weakness and pain) showed no statistical significance in our study
Conclusion:Respiratory failure in the course of GBS can to some extent, predicted depending on clinical information. Respiratory failure was associated with younger age, female gender, rapid progressive weakness, bulbar weakness. Facial weakness. Dense weakness, weak neck flexion, poor digit count and axonal neuropathy.
Keywords: Guillain Barre syndrome, respiratory failure, bulbar weakness, mechanical ventilation.


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