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Guillain-Barré syndrome

Management of respiratory failure

From the Neurological/Neurosurgical ICU, Department of Neurology (Dr. Ropperl, Massachusetts General Hospital, and the Department of Pediatric Neurology (Dr. Kehne), Boston City Hospital, Boston, MA.

Nineteen of 38 consecutive patients with Guillain-Barré syndrome were treated with mechanical ventilation in a neurological ICU. A ventilator was used for expiratory vital capacity (VC) below 12 to 15 ml/kg or arterial Po₂ below 70 mm Hg, or clinical signs of fatigue. Artificial ventilation was discontinued when VC reached 8 to 10 ml/kg. Twelve patients required tracheostomy at 11 days (mean) after intubation. Mechanical ventilation was required for 49 days (mean). Complications included pneumonia in 15 patients, mostly aspiration, only 1 severe; pulmonary embolus in 1 ventilated and 1 nonventilated patient; and tracheal stenosis in 1. There was one death in a previously unintubated patient who developed sepsis while improving from GBS, and no deaths in the 18 other intubated patients.

Address correspondence and reprint requests to Dr. Ropper, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114.

Accepted for publication February 6. 1985.

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