Mechanical ventilation in Guillain–Barré syndrome

ABSTRACT

Introduction: Up to 30% of patients with Guillain–Barré syndrome (GBS) develop respiratory failure requiring intensive care unit (ICU) admission and mechanical ventilation. Progressive weakness of the respiratory muscles is the leading cause of acute respiratory distress and respiratory failure with hypoxia and/or hypercarbia. Bulbar weakness may compromise airway patency and predispose patients to aspiration pneumonia.

Areas covered: Clinical questions related to the use of mechanical ventilation include but are not limited to: When to start? Invasive or noninvasive? When to wean from mechanical ventilation? When to perform tracheostomy? How to manage complications of GBS in the ICU including nosocomial infection, ventilator-associated pneumonia, and ICU-acquired weakness? In this narrative review, the authors summarize the up-to-date knowledge of the incidence, pathophysiology, evaluation, and general management of respiratory failure in GBS.

Expert opinion: Respiratory failure in GBS merits more attention from caregivers. Emergency intubation may lead to life-threatening complications. Appropriate methods and time point of intubation and weaning, an early tracheostomy, and predictive prophylaxis of complications benefit patients’ long-term prognosis.

KEYWORDS:

• Guillain–Barré syndrome
• intensive care
• mechanical ventilation
• respiratory failure
• tracheostomy

Acknowledgments

We thank Dr. Rabinstein for revising this manuscript. We thank Mr. Peyton Lee for proofreading this manuscript.

Article highlights

• Up to 30% of patients with GBS develop respiratory failure and need mechanical ventilation.

• Weakness of respiratory muscles, involvement of autonomic nerves, and progressive bulbar palsy are major factors involved in GBS-associated respiratory failure.

• Mechanical ventilation needs to be applied when patients meet respiratory failure criteria; several clinical signs including rapid progressive motor deficits and ineffective cough could help to predict up-coming respiratory failure.

• Invasive ventilation is recommended in GBS patients to avoid aspiration pneumonia and emergency intubation-related life-threatening complications.

• The weaning process mainly depends on inspiratory force and vital capacity; caregivers should not predict weaning solely based on the extremity muscle strength.

• Early tracheostomy may provide more comfort, earlier oral nutrition, adequate oral hygiene, easier oral communication, and out-of-bed mobilization to GBS patients.

• Complications including ICU-acquired weakness, deep venous thrombosis, ventilator-associated pneumonia, and hyperglycemia need to be cautioned; early rehabilitation might be useful in reducing long-term complications such as pain and fatigue.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The work was supported by the National Key R&D Program of China (No. 2017YFC0110304 to JF) and grants from the National Natural Science Foundation of China to (No. 81771257 to JF) and the Science and Technology Planning Project of Jilin Province (No.20180520110JH to MZ)