Mechanical ventilation in patients with Guillain-Barré syndrome

Mohamed I. Ali, Evans R. Fernández-Pérez, Shanthan Pendem, Daniel R. Brown, Eelco F M Wijdicks, Ognjen Gajic

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Patients with Guillain-Barré syndrome are commonly exposed to prolonged mechanical ventilation. Specific data on ventilatory management of these patients have been limited. OBJECTIVE: To describe the practice of mechanical ventilation in patients with Guillain-Barré syndrome and evaluate risk factors for morbidity and mortality. METHODS: We describe a historical cohort of mechanically ventilated patients with Guillain-Barré syndrome in a tertiarycare center. We extracted database information on demographics, severity of illness, pulmonary function, and ventilatory management for the period 1976 to 1996. Primary outcomes were development of pulmonary complications, duration of ventilatory support, and mortality. RESULTS: Fifty-four patients met the inclusion criteria. After 1990, lower tidal volume (p = 0.031) and higher positive end-expiratory pressure (p = 0.003) were used than during the 1976 to 1990. Outcomes did not change significantly during the studied period. Forty-six patients (85%) survived to hospital discharge, and 39 (72%) were alive at 1-year follow-up. Ventilator-associated pneumonia was the most frequent complication (56%) and was associated with prolonged mechanical ventilation (p < 0.01). Atelectasis developed in 49%, and acute lung injury in 13%. All but 6 patients (89%) received tracheostomy. In 14 patients (30%) tracheostomy was placed ≥ 14 days after intubation. When adjusted for atelectasis and severity of illness in a stepwise logistic regression analysis, delayed tracheostomy was associated with the development of ventilator-associated pneumonia (odds ratio 8.2, p = 0.029). CONCLUSIONS: Changes in ventilator practice did not affect outcomes of mechanically ventilated patients with Guillain-Barré syndrome. The majority of patients received tracheostomy, which should be considered early in the course of respiratory failure.

Original languageEnglish (US)
Pages (from-to)1403-1407
Number of pages5
JournalRespiratory Care
Volume51
Issue number12
StatePublished - Dec 2006

Fingerprint

Artificial Respiration
Tracheostomy
Ventilator-Associated Pneumonia
Pulmonary Atelectasis
Lung
Positive-Pressure Respiration
Mortality
Acute Lung Injury
Tidal Volume
Mechanical Ventilators
Intubation
Respiratory Insufficiency
Logistic Models
Odds Ratio
Regression Analysis
Demography
Databases
Morbidity

Keywords

  • Atelectasis
  • Neuromuscular disease
  • Respiration
  • Respiratory insufficiency
  • Tidal volume
  • Weaning

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Pulmonary and Respiratory Medicine

Cite this

Ali, M. I., Fernández-Pérez, E. R., Pendem, S., Brown, D. R., Wijdicks, E. F. M., & Gajic, O. (2006). Mechanical ventilation in patients with Guillain-Barré syndrome. Respiratory Care, 51(12), 1403-1407.

Mechanical ventilation in patients with Guillain-Barré syndrome. / Ali, Mohamed I.; Fernández-Pérez, Evans R.; Pendem, Shanthan; Brown, Daniel R.; Wijdicks, Eelco F M; Gajic, Ognjen.

In: Respiratory Care, Vol. 51, No. 12, 12.2006, p. 1403-1407.

Research output: Contribution to journalArticle

Ali, MI, Fernández-Pérez, ER, Pendem, S, Brown, DR, Wijdicks, EFM & Gajic, O 2006, 'Mechanical ventilation in patients with Guillain-Barré syndrome', Respiratory Care, vol. 51, no. 12, pp. 1403-1407.
Ali MI, Fernández-Pérez ER, Pendem S, Brown DR, Wijdicks EFM, Gajic O. Mechanical ventilation in patients with Guillain-Barré syndrome. Respiratory Care. 2006 Dec;51(12):1403-1407.
Ali, Mohamed I. ; Fernández-Pérez, Evans R. ; Pendem, Shanthan ; Brown, Daniel R. ; Wijdicks, Eelco F M ; Gajic, Ognjen. / Mechanical ventilation in patients with Guillain-Barré syndrome. In: Respiratory Care. 2006 ; Vol. 51, No. 12. pp. 1403-1407.
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abstract = "BACKGROUND: Patients with Guillain-Barr{\'e} syndrome are commonly exposed to prolonged mechanical ventilation. Specific data on ventilatory management of these patients have been limited. OBJECTIVE: To describe the practice of mechanical ventilation in patients with Guillain-Barr{\'e} syndrome and evaluate risk factors for morbidity and mortality. METHODS: We describe a historical cohort of mechanically ventilated patients with Guillain-Barr{\'e} syndrome in a tertiarycare center. We extracted database information on demographics, severity of illness, pulmonary function, and ventilatory management for the period 1976 to 1996. Primary outcomes were development of pulmonary complications, duration of ventilatory support, and mortality. RESULTS: Fifty-four patients met the inclusion criteria. After 1990, lower tidal volume (p = 0.031) and higher positive end-expiratory pressure (p = 0.003) were used than during the 1976 to 1990. Outcomes did not change significantly during the studied period. Forty-six patients (85{\%}) survived to hospital discharge, and 39 (72{\%}) were alive at 1-year follow-up. Ventilator-associated pneumonia was the most frequent complication (56{\%}) and was associated with prolonged mechanical ventilation (p < 0.01). Atelectasis developed in 49{\%}, and acute lung injury in 13{\%}. All but 6 patients (89{\%}) received tracheostomy. In 14 patients (30{\%}) tracheostomy was placed ≥ 14 days after intubation. When adjusted for atelectasis and severity of illness in a stepwise logistic regression analysis, delayed tracheostomy was associated with the development of ventilator-associated pneumonia (odds ratio 8.2, p = 0.029). CONCLUSIONS: Changes in ventilator practice did not affect outcomes of mechanically ventilated patients with Guillain-Barr{\'e} syndrome. The majority of patients received tracheostomy, which should be considered early in the course of respiratory failure.",
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AU - Wijdicks, Eelco F M

AU - Gajic, Ognjen

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N2 - BACKGROUND: Patients with Guillain-Barré syndrome are commonly exposed to prolonged mechanical ventilation. Specific data on ventilatory management of these patients have been limited. OBJECTIVE: To describe the practice of mechanical ventilation in patients with Guillain-Barré syndrome and evaluate risk factors for morbidity and mortality. METHODS: We describe a historical cohort of mechanically ventilated patients with Guillain-Barré syndrome in a tertiarycare center. We extracted database information on demographics, severity of illness, pulmonary function, and ventilatory management for the period 1976 to 1996. Primary outcomes were development of pulmonary complications, duration of ventilatory support, and mortality. RESULTS: Fifty-four patients met the inclusion criteria. After 1990, lower tidal volume (p = 0.031) and higher positive end-expiratory pressure (p = 0.003) were used than during the 1976 to 1990. Outcomes did not change significantly during the studied period. Forty-six patients (85%) survived to hospital discharge, and 39 (72%) were alive at 1-year follow-up. Ventilator-associated pneumonia was the most frequent complication (56%) and was associated with prolonged mechanical ventilation (p < 0.01). Atelectasis developed in 49%, and acute lung injury in 13%. All but 6 patients (89%) received tracheostomy. In 14 patients (30%) tracheostomy was placed ≥ 14 days after intubation. When adjusted for atelectasis and severity of illness in a stepwise logistic regression analysis, delayed tracheostomy was associated with the development of ventilator-associated pneumonia (odds ratio 8.2, p = 0.029). CONCLUSIONS: Changes in ventilator practice did not affect outcomes of mechanically ventilated patients with Guillain-Barré syndrome. The majority of patients received tracheostomy, which should be considered early in the course of respiratory failure.

AB - BACKGROUND: Patients with Guillain-Barré syndrome are commonly exposed to prolonged mechanical ventilation. Specific data on ventilatory management of these patients have been limited. OBJECTIVE: To describe the practice of mechanical ventilation in patients with Guillain-Barré syndrome and evaluate risk factors for morbidity and mortality. METHODS: We describe a historical cohort of mechanically ventilated patients with Guillain-Barré syndrome in a tertiarycare center. We extracted database information on demographics, severity of illness, pulmonary function, and ventilatory management for the period 1976 to 1996. Primary outcomes were development of pulmonary complications, duration of ventilatory support, and mortality. RESULTS: Fifty-four patients met the inclusion criteria. After 1990, lower tidal volume (p = 0.031) and higher positive end-expiratory pressure (p = 0.003) were used than during the 1976 to 1990. Outcomes did not change significantly during the studied period. Forty-six patients (85%) survived to hospital discharge, and 39 (72%) were alive at 1-year follow-up. Ventilator-associated pneumonia was the most frequent complication (56%) and was associated with prolonged mechanical ventilation (p < 0.01). Atelectasis developed in 49%, and acute lung injury in 13%. All but 6 patients (89%) received tracheostomy. In 14 patients (30%) tracheostomy was placed ≥ 14 days after intubation. When adjusted for atelectasis and severity of illness in a stepwise logistic regression analysis, delayed tracheostomy was associated with the development of ventilator-associated pneumonia (odds ratio 8.2, p = 0.029). CONCLUSIONS: Changes in ventilator practice did not affect outcomes of mechanically ventilated patients with Guillain-Barré syndrome. The majority of patients received tracheostomy, which should be considered early in the course of respiratory failure.

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