Clinical Predictors Of Mechanical Ventilation In Guillain-Barre Syndrome

Guillain-Barre syndrome (GBS), one of the most common neuromuscular emergencies, is an immune-mediated, rapidly progressive, predominantly motor polyneuropathy that often leads to bulbar and respiratory compromise. The prognosis for recovery in patients with GBS can be favorable, with only minor residual symptoms in most of them. However, the mortality rate ranges from 2% to 12%. Respiratory failure requiring invasive mechanical ventilation is the most serious short-term complication of Guillain-Barre syndrome. Mechanical ventilation has been reported to be needed in about 20%to 30% of patients, The onset of respiratory failure in GBS is insidious and the progress is not gradual but skipping as failure-compensation-decompensation. If we can not identify and manage it early, the risk of life-threatening complications such as respiratory arrest or aspiration pneumonia will increase. Therefore, it is crucial to identify predictors of mechanical ventilation in Guillain-Barre syndrome. A series of studies about it have been conducted in foreign countries, but the predictors they obtained are not identified with each other. However, the relative study in our country is not enough and. The large-scale and systemic study has not conduct in our country. For establishing the foundation of large-sample and systemic study, we conduct this sudy. On the basis of previous experience and the conditions in our country, we selected convenientand practical factors and sought to identify clinical predictors of mechanical ventilation in Guillain-Barre syndrome in order to guide the early identification and management of patients at risk for respiratory failure, and maximize the potential for survival.We retrospectively reviewed the medical records of 231 patients with GBS admitted to the department of neurology in the first hospital of Jilin University between October 1999 and September 2006. Clinical datas were compared between ventilated and non-ventilated patients, including age, sex, season, antecedent infection, time to peak disability, time to weakness of all limbs, disability grade, ineffective coughing, sensory loss in limbs, bifacial weakness, bulbar paralysis, tendon reflex,autonomic dysfunction, pneumonia, treatment. All of the analyses were conducted using SAS,α=0.05. After Univariate Analyses and Multivariate Analyses, we identify the predictors of mechanical ventilation. At last, we analyzed the relationship between the number of predictors and mechanical ventilation.The result of our study showed amid the 231 patients with GBS, mechanical ventilation was required in 47 patients (20.35%). Univariate Analyses identified the predictors as follws: early peak disability, low grade of diability, male, autumn, upper respiratory tract infection or diarrhea within one month preceding GBS onset, ineffective coughing, normal sense, bifacial weakness, bulbar paralysis, pneumonia, not treatment with immunoglobulin. The factor of upper respiratory tract infection within one month preceding GBSonset was also investigated in the multivariate analysis because its P value is close to 0.05. Multivariate analyses identified seven predictors of mechanical ventilation: pneumonia (OR=100.685), ineffective coughing (OR=19.3610), upper respiratory tract infection within one month preceding GBS onset (OR=8.552), bulbar paralysis(OR=7.923), early peak disability (OR=0.671), low grade of diability (OR=0.266), not treatment with immunoglobulin (OR=0.021). None of the patients who have less than 3 predictors requires mechanical ventilation; when the patients have 3 to 6 predictors, the mechanical ventilation rate is 7%, 45%, 85% and 100%, respectively. There is no patients with all the7 predictors in our study .From this study we conclude that the predictors of mechanical ventilation include pneumonia, ineffective coughing, upper respiratory tract infection within one month preceding GBS onset, bulbar paralysis, early peak disability, low grade of diability, not treatment with intravenous immunoglobulin. Pneumonia is the strongest predictor of mechanical ventilation. When the patients have one or two predictors, the possibility of mechanical ventilation is minor; When the patients have three or more predictors in our study, the possibility of mechanical ventilation increases as the number of predictors increases. When the patients have one or two predictors in our study, we should pay more attention to them, prevent and cure Pneumonia and treat them with intravenous immunoglobulin; Patients with three or four predictors should be monitored in an intensive careunit; When the patients have five or more predictors, we should make arrangement for tracheotomia and mechanical ventilation .In conclusion, our results are convenient and practical, which allow early identification and management of patients at risk for respiratory failure. Finally, it would be of interest to seek confirmation of our results in a prospective cohort of GBS patients or a large-sample and systemic study, and on the basis of these results, we make a scoring system for predicting the respiratory failure in GBS.