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Neurology India, Vol. 51, No. 4, October-December, 2003, pp. 559 Letter To Editor Mechanical ventilation in Guillain-Barre syndrome Kumar S Department of Neurological Sciences, Christian Medical College Hospital, Vellore - 632004 Code Number: ni03181 Sir, I read with interest the recent article by Aggarwal et al.[1] They have presented an excellent and comprehensive account of ventilatory management in patients with severe Guillain-Barre syndrome (GBS). However, I would like to make certain comments. Firstly, what percentage of patients in their center needed ventilation? They have studied a total of 11 cases over a four-year period; however, the total number of patients observed during the same period has not been mentioned. This is an important issue as most of the centers equipped to manage GBS have a shortage of intensive care unit (ICU) beds and mechanical ventilators. This problem is compounded by the need of prolonged periods of ventilation in GBS, as mentioned by Aggarwal et al. Secondly, it would have been useful if data were provided about factors that predicted the need of mechanical ventilation in their patients. Based on previous studies, factors predicting the need of endotracheal intubation are: shorter duration between onset and admission (less than seven days), inability to cough, inability to stand, inability to lift the elbows or head and elevated liver enzymes.[2] In children, onset of symptoms of GBS within eight days of preceding infection, cranial nerve involvement and cerebrospinal fluid protein >800 mg/dl were associated with a higher risk of respiratory failure.[3] Knowledge of these factors could guide physicians in anticipating the need of mechanical ventilation in patients with GBS. Thirdly, the role of electrophysiological studies in predicting the need of mechanical ventilation has been inadequately discussed. In a recent prospective study, evidence of electrophysiological demyelination predicted a need of endotracheal intubation and mechanical ventilation.[4] It would have been interesting if Aggarwal et al had mentioned the proportion of patients in their study belonging to demyelinating and axonal groups of GBS who went on to require mechanical ventilation. Finally, the timing and use of tracheostomy has not been completely studied. About 80% of mechanically ventilated patients with GBS require ventilation for more than three weeks.[5] Factors associated with prolonged period of ventilation are an older age and presence of underlying pulmonary disease. Serial post-intubation pulmonary function tests may help predict the duration of ventilation and need for tracheostomy.[6] References
Copyright 2003 - Neurology India Free full text also available from: http://www.neurologyindia.com/article.asp?issn=0028-3886;year=2003;volume=51;issue=4;spage=559;epage=559;aulast=Kumar |
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