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Research ArticleOriginal Contributions

Mechanical Ventilation in Patients With Guillain-Barré Syndrome

Mohamed I Ali, Evans R Fernández-Pérez, Shanthan Pendem, Daniel R Brown, Eelco FM Wijdicks and Ognjen Gajic
Respiratory Care December 2006, 51 (12) 1403-1407;
Mohamed I Ali
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, Saint Mary's Duluth Clinic Health System, Duluth, Minnesota.
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Evans R Fernández-Pérez
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
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Shanthan Pendem
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, St Alexius Medical Center, Bismarck, North Dakota.
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Daniel R Brown
Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota.
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Eelco FM Wijdicks
Department of Neurology, Mayo Clinic, Rochester, Minnesota.
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Ognjen Gajic
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
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  • For correspondence: [email protected]
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Abstract

BACKGROUND: Patients with Guillain-Barré syndrome are commonly exposed to prolonged mechanical ventilation. Specific data on ventilatory management of these patients have been limited.

OBJECTIVE: To describe the practice of mechanical ventilation in patients with Guillain-Barré syndrome and evaluate risk factors for morbidity and mortality.

METHODS: We describe a historical cohort of mechanically ventilated patients with Guillain-Barré syndrome in a tertiarycare center. We extracted database information on demographics, severity of illness, pulmonary function, and ventilatory management for the period 1976 to 1996. Primary outcomes were development of pulmonary complications, duration of ventilatory support, and mortality.

RESULTS: Fifty-four patients met the inclusion criteria. After 1990, lower tidal volume (p = 0.031) and higher positive end-expiratory pressure (p = 0.003) were used than during the 1976 to 1990. Outcomes did not change significantly during the studied period. Forty-six patients (85%) survived to hospital discharge, and 39 (72%) were alive at 1-year follow-up. Ventilator-associated pneumonia was the most frequent complication (56%) and was associated with prolonged mechanical ventilation (p < 0.01). Atelectasis developed in 49%, and acute lung injury in 13%. All but 6 patients (89%) received tracheostomy. In 14 patients (30%) tracheostomy was placed ≥ 14 days after intubation. When adjusted for atelectasis and severity of illness in a stepwise logistic regression analysis, delayed tracheostomy was associated with the development of ventilator-associated pneumonia (odds ratio 8.2, p = 0.029).

CONCLUSIONS: Changes in ventilator practice did not affect outcomes of mechanically ventilated patients with Guillain-Barré syndrome. The majority of patients received tracheostomy, which should be considered early in the course of respiratory failure.

  • neuromuscular disease
  • respiratory insufficiency
  • respiration
  • weaning
  • atelectasis
  • tidal volume

Footnotes

  • Correspondence: Ognjen Gajic MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester MN 55905. E-mail: gajic.ognjen{at}mayo.edu.
  • The authors report no conflicts of interest related to the content of this paper.

  • Copyright © 2006 by Daedalus Enterprises Inc.
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Respiratory Care: 51 (12)
Respiratory Care
Vol. 51, Issue 12
1 Dec 2006
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Mechanical Ventilation in Patients With Guillain-Barré Syndrome
Mohamed I Ali, Evans R Fernández-Pérez, Shanthan Pendem, Daniel R Brown, Eelco FM Wijdicks, Ognjen Gajic
Respiratory Care Dec 2006, 51 (12) 1403-1407;

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Mechanical Ventilation in Patients With Guillain-Barré Syndrome
Mohamed I Ali, Evans R Fernández-Pérez, Shanthan Pendem, Daniel R Brown, Eelco FM Wijdicks, Ognjen Gajic
Respiratory Care Dec 2006, 51 (12) 1403-1407;
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Keywords

  • neuromuscular disease
  • respiratory insufficiency
  • respiration
  • weaning
  • atelectasis
  • tidal volume

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