Francois Fourrier , Laurent Robriquet , Jean-Francois Hurtevent and Shirley Spagnolo. Critical Care 2011, 15:R65doi:10.1186/cc10043. Published: 21 February 2011
Abstract (provisional)
Introduction
Patients suffering from Guillain-Barre syndrome (GBS) may frequently develop an acute respiratory failure and need ventilatory support. Immune therapy using plasma exchange or immunoglobulins has modified the natural course of the disease and by decreasing the length of the plateau phase, may induce a rapid improvement in ventilatory function. However a substantial proportion of patients still require prolonged mechanical ventilation (MV) and tracheotomy. The present study was designed to search for simple functional markers that could predict the need for prolonged MV just after completion of immune therapy.
Methods
We analyzed the data collected in a cohort of patients with GBS admitted to the intensive care unit (ICU) of our university hospital between 1996 and 2009. Demographic, clinical, biological and electrophysiologic data, results of sequential spirometry, times of endotracheal intubation, tracheotomy, and MV weaning were prospectively collected for all patients. Sequential daily neurological testing used standardized data collection by the same investigators all along the study period. Results were compared by single and multiple regression analysis at admission to ICU and at the end of immune therapy, according to the need and duration of MV ([less than or equal to] or > 15 days).
Results
61 patients with severe GBS were studied. 66% required MV (median length: 24 days). The lack of foot flexion ability at ICU admission and at the end of immunotherapy was significantly associated with a MV length > 15 days (positive predictive value: 82%; odd ratio: 5.4 [1.2 – 23.8] and 82%; 6.4 [1.4 – 28.8], respectively). The association of a sciatic nerve motor conduction block with the lack of foot flexion at the end of immunotherapy was associated with prolonged MV with a 100% positive predictive value.
Conclusions
In patients admitted to ICU with Guillain-Barre syndrome and acute respiratory failure, the lack of foot flexion ability at the end of immune therapy predicts a prolonged duration of MV. Combined with a sciatic motor conduction block, it may be a strong argument to perform an early tracheotomy.
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