Pearls and Pitfalls in the Intensive Care Management of Guillain-Barré Syndrome

ABSTRACT

Approximately one third of patients with Guillain-Barré syndrome (GBS) need to be admitted to the intensive care unit (ICU) because of respiratory failure. A significant proportion of patients require ICU admission because of dysautonomia or because of medical or iatrogenic complications. Recognition of the clinical manifestations and the paraclinical findings in patients with neuromuscular respiratory failure is essential to ensure mechanical ventilation promptly. In the ICU, attention to positioning, nutrition, analgesia, and psychological support are crucial. Recognition of autonomic dysfunction and of the rare need for intervention is important to avoid iatrogenic complications. Prognosis determination in GBS is based on the clinical history, epidemiological factors, and neurologic examination.

KEYWORD

Guillain-Barré - syndrome - intensive care - management - complications - neuromuscular respiratory failure

REFERENCES

• 1 Hahn A. Guillain-Barré syndrome.  Lancet . 1998;  352 635-641
• 2 Borel C O, Guy J. Ventilatory management in critical neurologic illness. In: Jordan KG, ed. Neurologic Clinics Philadelphia: WB Saunders 1995: 627-644
• 3 Ropper A H, Wijdicks E FM, Truax B T. General care. In: Ropper AH, Wijdicks EFM, Truax BT, eds. Guillain-Barré Syndrome Philadelphia: FA Davis 1991: 237-252
• 4 Fulgham J R, Wijdicks E FM. Guillain-Barré syndrome. In: Diringer M, ed. Critical Care Clinics: Update on Neurologic Critical Care Philadelphia: WB Saunders 1997: 1-15
• 5 Hahn A. Intravenous immunoglobulin treatment in peripheral nerve disorders: indications, mechanisms of action and side effects.  Curr Opin Neurol . 2000;  13 575-582
• 6 Moulin D E, Hagen N, Feasby T E, Amireh R, Hahn A. Pain in Guillain-Barré syndrome.  Neurology . 1997;  48 328-331
• 7 Roubenoff R A, Borel C O, Hanley D F. Hypermetabolism and hypercatabolism in Guillain-Barré syndrome.  JPEN J Parenter Enteral Nutr . 1992;  16 464-472
• 8 Ropper A H, Wijdicks E FM, Truax B T. Clinical features of the typical syndrome. In: Ropper AH, Wijdicks EFM, Truax BT, eds. Guillain-Barré Syndrome Philadelphia: FA Davis 1991: 73-105
• 9 Bowes D. The doctor as a patient: an encounter with Guillain-Barré syndrome.  Can Med Assoc J . 1984;  131 1343-1348
• 10 Tripathi M, Kaushik S. Carbamazepine for pain management in Guillain-Barré syndrome patients in the intensive care unit.  Crit Care Med . 2000;  28 655-658
• 11 Wang N, Chapman J, Rabinowitz R, Viskin S, Kafri M, Korczyn A D. Autonomic dysfunction in experimental autoimmune neuritis.  J Neurol Sci . 2001;  184 183-188
• 12 Yamamoto K, Sobue G, Iwase S, Nagamatsu M, Mano T, Mitsuma T. Skin sympathetic nerve activity in Guillain-Barré syndrome: a microneurographic study.  J Neurol Neurosurg Psychiatry . 1997;  63 537-541
• 13 Seneviratne U. Guillain-Barré syndrome.  Postgrad Med J . 2000;  76 774-782
• 14 Stangel M, Hartung H-P, Marx P, Gold R. Intravenous immunoglobulin treatment of neurological autoimmune diseases.  J Neurol Sci . 1998;  153 203-214
• 15 Mahalati K, Dawson R B, Collins J O, Lietman S, Pearlman S, Gulden D. Characteristics of 73 patients, 1984-1973, treated by plasma exchange for Guillain-Barré syndrome.  J Clin Apheresis . 1997;  12 116-121
• 16 Yuki N, Kuwabara S, Koga M, Hirata K. Acute motor axonal neuropathy and acute motor-sensory axonal neuropathy share a common immunological profile.  J Neurol Sci . 1999;  168 121-126
• 17 Fletcher D D, Lawn N D, Wolter T D, Wijdicks E F. Long-term outcome in patients with Guillain-Barré syndrome requiring mechanical ventilation.  Neurology . 2000;  54 2311-2315
• 18 Visser L H, Schmitz P IM, Meulstee J, Van Doorn A P, Van der Meche G A F. Prognostic factors of Guillain-Barré syndrome after intravenous immunoglobulin or plasma exchange. Dutch Guillain-Barré Study Group.  Neurology . 1999;  53 598-562
• 19 Mokuno K, Kiyosawa K, Sugimura K. Prognostic value of cerebrospinal fluid neuron-specific enolase and S-100b protein in Guillain-Barré syndrome.  Acta Neurol Scand . 1994;  89 27-30