The morbidity and outcome of patients with Guillain–Barré syndrome admitted to the intensive care unit

doi:10.1016/j.jns.2007.08.005

Journal of the Neurological Sciences

Volume 264, Issues 1–2, 15 January 2008, Pages 121-128

https://doi.org/10.1016/j.jns.2007.08.005 Get rights and content

Abstract

One third of patients with Guillain–Barré syndrome (GBS) require admission to the intensive care unit (ICU), associated with significant risk of morbidity, mortality, and incomplete recovery.

Methods

76 adult patients with GBS admitted to the ICU at a regional referral center over a 20-year period were studied. We determined the frequency, nature, and predictors of complications they experienced while in the ICU; this morbidity was related to long-term functional recovery and time to regain independent ambulation, extracted from longitudinal follow-up data.

Results

ICU stay was a median 21 days and mechanical ventilation (MV) was required in 78% (median duration 28 days). Two-thirds suffered at least one major complication, most commonly pneumonia (54%). Morbidity was strongly associated with MV and male sex. Mortality occurred in only 5 patients (6.5%). Over an average 3 years follow-up, recovery of independent ambulation was seen in 75%, with advanced age being the most powerful predictor of poor outcome. Prolonged MV and severe axonal loss did not preclude a favorable recovery. Time to ambulate was a median 198 days, although recovery could occur as late as ten years after onset; slower recovery was associated with ICU complications, prolonged MV, and early axonal abnormalities.

Conclusion

Although patients with GBS suffer significant morbidity during protracted ICU stays, with meticulous supportive care, many make gratifying functional recoveries. In severely afflicted patients, this may only be appreciated after extended follow-up.

Introduction

Guillain–Barré syndrome (GBS) manifests as an acutely evolving paralytic illness that may rapidly progress to quadriplegia, weakness of bulbar and respiratory musculature, and autonomic nervous system dysfunction [1]. Approximately one third of GBS patients are admitted to an intensive care unit (ICU); many require mechanical ventilation (MV), often for prolonged periods [2], [3], [4]. During this critical phase, they are at risk for systemic complications with the potential for substantial morbidity and consequent mortality [5], [6]. These severely afflicted patients have a less favourable prognosis for functional recovery, suffer greater long-term disability, and expend substantial personal and health-care costs [7]. The nature and extent of morbidity experienced by these patients while in the ICU and its impact on outcome has only been explored in a limited manner [8], [9]. This knowledge could help identify correctable factors, optimize medical care, and guide discussions of prognosis with patients and their families.

We undertook a retrospective review of all adult patients with GBS admitted to the ICU at our institution over a twenty year period to delineate the spectrum of complications they suffer while critically ill, to determine the rates of severe morbidity and mortality, and to assess long-term functional outcome. We extracted predictors of complications and of eventual recovery, and determined specifically how ICU morbidity impacts on rate of recovery and long-term prognosis.

Section snippets

Methods

The medical records of all patients with a diagnosis of GBS who were admitted to the ICU at London Health Sciences Centre between 1983 and 2003 were reviewed. We excluded children and those subsequently found to have mimics of GBS, including CIDP. Patient demographics and medical comorbidities were recorded; organ dysfunction (including cardiac and pulmonary disease), diabetes mellitus, and coronary artery disease were considered serious comorbidities. Respiratory or gastrointestinal infections

Results

Demographic information and the clinical characteristics of the 76 patients eligible for study are shown in Table 1. The majority of these GBS patients experienced a fulminant disease course, requiring ICU admission a median of 5 days from onset; peak severity was reached after a median of 8 days with 74% of patients having complete paralysis or only a flicker of upper limb movement. Indication for ICU admission was respiratory failure in most cases; most patients with bulbar dysfunction (87%)

Discussion

This study examines the subgroup of patients with the most severe GBS, those requiring admission to the ICU, usually for impending respiratory failure, bulbar weakness resulting in inability to protect their airway, or autonomic instability. It confirms that this population has prolonged ICU stays, often coupled with a number of potentially life-threatening complications. The high rate of major complications in our cohort is comparable to that reported in the only other large study from the

Acknowledgements

Financial disclosure: None

Funding/support: This research was supported by the GBS/CIDP patients' donation fund and by a stipend from Bayer Canada.

Role of the sponsors: Funding sources had no role in the design or conduct of the study, the collection or analysis of the data, or the preparation or review of the final manuscript for submission. The corresponding author had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the

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The morbidity and outcome of patients with Guillain–Barré syndrome admitted to the intensive care unit

Abstract

Methods

Results

Conclusion

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgements

Lancet

Management of Guillain–Barré syndrome

Baillieres Clin Neurol

A prospective study of acute idiopathic neuropathy. I. Clinical features and their prognostic value

J Neurol Neurosurg Psychiatry

Epidemiological study of Guillain–Barré syndrome in south east England

J Neurol Neurosurg Psychiatry

Early predictors of mechanical ventilation in Guillain–Barré syndrome

Crit Care Med

Severe acute Guillain–Barré syndrome

Neurology

Fatal Guillain–Barré syndrome

Neurology

Long-term outcome in patients with Guillain–Barré syndrome requiring mechanical ventilation

Neurology

The morbidity of Guillain–Barré syndrome admitted to the intensive care unit

Neurology

Management and outcome of severe Guillain–Barré syndrome

Q J Med