Functional Marker of Fourrier et al for the Need for Prolonged Mechanical Ventilation in a Patient with Guillain-Barre Syndrome

 

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

 

where:

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

 

Interpretation:

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

 

Performance:

• 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