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Research paper
Clinical outcome of Guillain-Barré syndrome after prolonged mechanical ventilation
  1. Bianca van den Berg1,
  2. Eline F Storm1,
  3. Marcel J P Garssen2,
  4. Patricia H Blomkwist-Markens3,
  5. Bart C Jacobs1,4
  1. 1Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2Department of Neurology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
  3. 3Spierziekten Nederland, Baarn, The Netherlands
  4. 4Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Dr Bart C Jacobs, Departments of Neurology and Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3000, The Netherlands; b.jacobs{at}erasmusmc.nl

Abstract

Background Patients with Guillain-Barré syndrome (GBS) may suffer from respiratory failure for months or longer. The aim of this study was to determine the frequency, clinical course and outcome of patients with GBS requiring prolonged mechanical ventilation (MV).

Methods Prospectively collected data from 526 patients with GBS participating in previous trials were analysed to determine the frequency and duration of prolonged MV (longer than 2 months). In addition, a cross-sectional study was conducted in patients with GBS requiring MV to determine the clinical course and long-term outcome with the ability to walk unaided as primary endpoint.

Results In the cohort study, 145 of 526 patients with GBS (28%) required MV, including 33 (6%) patients with prolonged MV. Patients requiring prolonged MV had a lower Medical Research Council sum score and more frequent bulbar involvement and inexcitable nerves compared with shorter ventilated patients. At 6 months, 18% of patients with prolonged MV were able to walk unaided compared with 76% of patients requiring shorter MV (P<0.001). In the cross-sectional study, 63 patients requiring MV were included with a median follow-up of 11 years (range 2–44 years). Twenty-six (41%) of these patients needed prolonged MV (median 93 days, range 62–261). Fifteen (58%) of these patients were able to walk unaided at maximum follow-up and eight (31%) reached this endpoint more than 1 year after diagnosis.

Conclusions Prolonged ventilation in GBS is associated with poor prognosis, yet patients requiring prolonged ventilation may show slow but persistent recovery for years and even reach the ability to walk and live independently.

  • guillain-barre syndrome

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Footnotes

  • Contributors BvdB: conceptualisation of the study, analysis and interpretation of the data, and drafting and revising the manuscript. EFS: conceptualisation of the study, analysis and interpretation of the data, and drafting the manuscript. MJPG: conceptualisation of the study and revising the manuscript. PHB-M: conceptualisation of the study and revising the manuscript. BCJ: design and conceptualisation of the study, analysis and interpretation of the data, and drafting and revising the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests BCJ receives research support from the Netherlands Organization for Health Research and Development, Erasmus MC, Prinses Beatrix Spierfonds, Stichting Spieren voor Spieren, GBS-CIDP Foundation International, Grifols, CSL-Behring and Annexon.

  • Patient consent Obtained.

  • Ethics approval Local institutional review board Erasmus MC University Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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