Advertisement

Neurocritical Care

, Volume 5, Issue 3, pp 230–234 | Cite as

Factors predicting extubation success in patients with Guillain-Barré syndrome

  • Thanh N. NguyenEmail author
  • Neeraj Badjatia
  • Atul Malhotra
  • Fiona K. Gibbons
  • Muddasir M. Qureshi
  • Steven A. Greenberg
Perspectives in GBS

Abstract

Introduction

Accurate prediction of successful extubation in patients with Guillain-Barré syndrome (GBS) is an important clinical problem. We hypothesized that reversal of clinical indices used to intubate a patient (i.e., declining vital capacity [VC]) predict extubation.

Methods

This was a retrospective study in neurocritical care units at two teaching hospitals identifying all mechanically-ventilated patients with GBS.

Results

A total of 44 patients with GBS were included. Of these, 14 patients were successfully extubated. There were 10 failed extubations among six patients; and 20 patients underwent tracheostomy without an extubation trial. On the day of extubation, lower negative inspiratory force (NIF) (−50.3±12.7 versus −28.6±16.5 cm H2O, p=0.0005) and higher VC (21.9±8.4 versus 13.0±5.9 mL/kg, p=0.003) correlated with successful extubation. Change in VC preintubation to preextubation by greater than 4 mL/kg correlated with 82% sensitivity and 90% positive predictive value for successful extubation. Failed extubations were associated with the presence of pulmonary comorbidities (79 versus 36%, p=0.008) and autonomic dysfunction (73 versus 27%, p=0.008). Length of stay (LOS) in the intensive care unit (ICU) was increased in patients who failed extubation and in those patients who underwent tracheostomy (21.5±11.1 versus 12.5±8.7, p=0.005). In multivariate analysis, higher VC at extubation was associated with successful extubation (p=0.05).

Conclusions

In mechanically-ventilated patients with respiratory failure secondary to GBS, NIF less than −50 cm H2O, and VC improvement preextubation to preintubation by 4 mL/kg were significantly associated with successful extubation. Failed extubation or need for tracheostomy correlated with autonomic dysfunction, pulmonary comorbidities, and prolonged LOS in the ICU. Such parameters may be helpful in identifying patients with GBS likely to succeed extubation versus early referral for tracheostomy.

Key Words

Extubation Guillain-Barré syndrome mechanical ventilation vital capacity 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Winer JB, Hughes RA, Osmond C. A prospective study of acute idiopathic neuropathy. I. Clinical features and their prognostic value. J Neurol Neurosurg Psychiatry 1988;51(5):605–612.PubMedCrossRefGoogle Scholar
  2. 2.
    Lawn ND, Fletcher DD, Henderson RD, Wolter TD, Wijdicks EF. Anticipating mechanical ventilation in Guillain-Barre syndrome. Arch Neurol 2001;58(6):893–898.PubMedCrossRefGoogle Scholar
  3. 3.
    Ropper AH, Kehne SM. Guillain-Barré syndrome: management of respiratory failure. Neurology 1985;35:1662–1665.PubMedGoogle Scholar
  4. 4.
    Chevrolet JC, Deleamont P. Repeated vital capacity measurements as predictive parameters for mechanical ventilation need and weaning success in the Guillain-Barre syndrome. Am Rev Respir Dis 1991;144:814–818.PubMedGoogle Scholar
  5. 5.
    Van der Meche FG, Van Doorn PA, Meulstee J, Jennekens FG, Centre GB-cgotDNRS. Diagnostic and classification criteria for the Guillain-Barre syndrome. Eur Neurol 2001;45(3):133–139.PubMedCrossRefGoogle Scholar
  6. 6.
    Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barre syndrome. Ann Neurol 1990;27(Suppl): S21-S24.PubMedCrossRefGoogle Scholar
  7. 7.
    Yang KL, Tobin M. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 1991;324:1445–1450.PubMedCrossRefGoogle Scholar
  8. 8.
    Namen AM, Ely EW, Tatter SB, et al. Predictors of successful extubation in neurosurgical patients. Am J Respir Crit Care Med 2001;163:658–664.PubMedGoogle Scholar
  9. 9.
    Gracey DR, McMichan JC, Divertie MB, Howard FM Respiratory failure in Guillain-Barre syndrome: a 6-year experience. Mayo Clin Proc 1982;57:742–746.PubMedGoogle Scholar
  10. 10.
    Henderson RD, Lawn ND, Fletcher DD, McClelland RL, Wijdicks EF. The morbidity of Guillain-Barre syndrome admitted to the intensive care unit. Neurology 2003;60(1):17–21.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc. 2006

Authors and Affiliations

  • Thanh N. Nguyen
    • 1
    Email author
  • Neeraj Badjatia
    • 2
  • Atul Malhotra
    • 3
  • Fiona K. Gibbons
    • 3
  • Muddasir M. Qureshi
    • 4
  • Steven A. Greenberg
    • 5
  1. 1.Neurology Service, Department of Medicine and Department of RadiologyCentre Hospitalier de l'Université de MontréalMontrealCanada
  2. 2.Department of Neurology, Division of Stroke and Critical CareColumbia University Medical CenterNew York
  3. 3.Division of Pulmonary and Critical Care MedicineBrigham and Women's HospitalBoston
  4. 4.Department of NeurologyMassachusetts General HospitalBoston
  5. 5.Department of NeurologyBrigham and Women's HospitalBoston

Personalised recommendations