Fourrier et al identified several factors associated with the need for prolonged mechanical ventilation in a patient with Guillain-Barre Syndrome (GBS). These findings can help to identify a patient who may require an early tracheostomy. The authors are from Hopital Roger Salengro CHRU de Lille in France.


Patient selection: Guillain-Barre Syndrome


Outcome: need for mechanical ventilation > 15 days


Functional marker - both of the following:

(1) lack of foot flexion ability at the end of immune therapy

(2) presence of motor conduction block in the sciatic nerve



• Immune therapy consists of plasma exchange and/or intravenous infusion of immune globulins (IVIg).



• A person who fulfilled the functional marker will require prolonged mechanical ventilation. The patient may benefit from early tracheostomy.



• 100% specific but only 56% sensitive for prolonged mechanical ventilation (all who met criteria required prolonged mechanical ventilation, but only half of the people requiring prolonged mechanical ventilation were identified).


Factors associated with the need for mechanical ventilation (of any duration):

(1) high SAPS II score (mean 28)

(2) autonomic dysfunction

(3) delay in neurological improvement following immunotherapy


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