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Neurocritical Care
Published in: Neurocritical Care 1/2017

Open Access 01-02-2017 | Original Article

Tracheostomy or Not: Prediction of Prolonged Mechanical Ventilation in Guillain–Barré Syndrome

Authors: Christa Walgaard, Hester F. Lingsma, Pieter A. van Doorn, Mathieu van der Jagt, Ewout W. Steyerberg, Bart C. Jacobs

Published in: Neurocritical Care | Issue 1/2017

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Abstract

Background

Respiratory insufficiency occurs in 20 % of Guillain–Barré syndrome (GBS) patients, and the duration of mechanical ventilation (MV) ranges widely. We identified predictors of prolonged MV to guide clinical decision-making on tracheostomy.

Methods

We analyzed prospectively collected data from 552 patients with GBS in the context of two clinical trials and three cohort studies in The Netherlands. Potential predictors for prolonged MV, defined as duration of ≥14 days, were considered using crosstabs. Selected predictors were analyzed using Cox regression analysis.

Results

On a total of 150 (27 %) patients requiring MV, 106 (71 %) patients needed prolonged MV. The median duration of MV was 28 days (Interquartile Range [IQR] 12–60 days). The strongest observed predictors of prolonged MV were muscle weakness and axonal degeneration or unexcitable nerves on nerve conduction studies. Patients who are unable to lift the arms from the bed (bilateral Medical Research Council [MRC] of deltoid muscles of 0–2) at 1 week after intubation have an 87 % chance to require prolonged MV versus 69 % in patients who are able to lift the arms from the bed (bilateral MRC of deltoid muscles of 3–10). Patients in this last group who had axonal degeneration or unexcitable nerves on nerve conduction studies also have a 90 % chance to require prolonged MV.

Conclusions

Ventilated GBS patients who are unable to lift the arms from the bed and patients who have axonal degeneration or unexcitable nerves at 1 week are at high risk of prolonged MV, and tracheostomy should be considered in these patients.
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Metadata
Title
Tracheostomy or Not: Prediction of Prolonged Mechanical Ventilation in Guillain–Barré Syndrome
Authors
Christa Walgaard
Hester F. Lingsma
Pieter A. van Doorn
Mathieu van der Jagt
Ewout W. Steyerberg
Bart C. Jacobs
Publication date
01-02-2017
Publisher
Springer US
Published in
Neurocritical Care / Issue 1/2017
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-016-0311-5

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