Predictors for mechanical ventilation and short-term prognosis in patients with Guillain-Barré syndromeReportar como inadecuado




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Critical Care

, 19:310

First Online: 02 September 2015Received: 27 April 2015Accepted: 16 August 2015

Abstract

IntroductionGuillain-Barré syndrome GBS is an immune-mediated disorder of the peripheral nervous system. Respiratory failure requiring mechanical ventilation MV is a serious complication of GBS. Identification of modifiable risk factors for MV and poor short-term prognosis in mechanically ventilated patients with GBS may contribute to the individualized management and may help improve the outcome of the patients.

MethodsWe retrospectively analyzed the clinical data of 541 patients who were diagnosed with GBS from 2003 to 2014. Independent predictors for MV and short-term prognosis in mechanically ventilated patients were identified via multivariate logistic regression analysis.

ResultsThe mean age was 41.6 years with a male predilection 61.2 %. Eighty patients 14.8 % required MV. Multivariate analysis revealed that shorter interval from onset to admission p < 0.05, facial nerve palsy p < 0.01, glossopharyngeal and vagal nerve deficits p < 0.01 and lower Medical Research Council MRC sum score at nadir p < 0.01 were risk factors for MV; disease occurrence in summer p < 0.01 was a protective factor. As to prognostic factors, absence of antecedent infections p < 0.01 and lower MRC sum score at nadir p < 0.01 were predictors of poor short-term prognosis in mechanically ventilated patients regardless of treatment modality. We further investigated the predictors of poor short-term prognosis in patients requiring MV with different nadir MRC sum scores. Combined use of intravenous corticosteroids with intravenous immunoglobulin odds ratio 10.200, 95 % confidence interval 1.068–97.407, p < 0.05 was an independent predictor of poor short-term prognosis in mechanically ventilated patients with a nadir MRC sum score from 0 to 12 points, regardless of existence of antecedent infection.

ConclusionsClinical predictors of MV and poor short-term prognosis in mechanically ventilated GBS patients were distinct. Add-on use of intravenous corticosteroids was a risk factor for poor short-term prognosis in mechanically ventilated patients with a nadir MRC sum score from 0 to 12 points.

AbbreviationsAIDPAcute inflammatory demyelinating polyneuropathy

AMANAcute motor axonal neuropathy

CIMCritical illness myopathy

CIPCritical illness polyneuropathy

CMAPCompound muscular amplitude potential

GBSGuillain-Barré syndrome

HFGSHughes Functional Grading Scale

IVIgIntravenous immunoglobulin

MRCMedical Research Council

MVMechanical ventilation

p-dProximal-distal

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Autor: Xiujuan Wu - Chunrong Li - Bing Zhang - Donghui Shen - Ting Li - Kangding Liu - Hong-Liang Zhang

Fuente: https://link.springer.com/



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