Tracheostomy or Not: Prediction of Prolonged Mechanical Ventilation in Guillain–Barré Syndrome
Tóm tắt
Respiratory insufficiency occurs in 20 % of Guillain–Barré syndrome (GBS) patients, and the duration of mechanical ventilation (MV) ranges widely. We identified predictors of prolonged MV to guide clinical decision-making on tracheostomy. We analyzed prospectively collected data from 552 patients with GBS in the context of two clinical trials and three cohort studies in The Netherlands. Potential predictors for prolonged MV, defined as duration of ≥14 days, were considered using crosstabs. Selected predictors were analyzed using Cox regression analysis. On a total of 150 (27 %) patients requiring MV, 106 (71 %) patients needed prolonged MV. The median duration of MV was 28 days (Interquartile Range [IQR] 12–60 days). The strongest observed predictors of prolonged MV were muscle weakness and axonal degeneration or unexcitable nerves on nerve conduction studies. Patients who are unable to lift the arms from the bed (bilateral Medical Research Council [MRC] of deltoid muscles of 0–2) at 1 week after intubation have an 87 % chance to require prolonged MV versus 69 % in patients who are able to lift the arms from the bed (bilateral MRC of deltoid muscles of 3–10). Patients in this last group who had axonal degeneration or unexcitable nerves on nerve conduction studies also have a 90 % chance to require prolonged MV. Ventilated GBS patients who are unable to lift the arms from the bed and patients who have axonal degeneration or unexcitable nerves at 1 week are at high risk of prolonged MV, and tracheostomy should be considered in these patients.
Tài liệu tham khảo
Dhar R, Stitt L, Hahn AF. The morbidity and outcome of patients with Guillain–Barre syndrome admitted to the intensive care unit. J Neurol Sci. 2008;264(1–2):121–8.
Fletcher DD, Lawn ND, Wolter TD, Wijdicks EF. Long-term outcome in patients with Guillain–Barre syndrome requiring mechanical ventilation. Neurology. 2000;54(12):2311–5.
Rees JH, Thompson RD, Smeeton NC, Hughes RA. Epidemiological study of Guillain–Barre syndrome in south east England. J Neurol Neurosurg Psychiatry. 1998;64(1):74–7.
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):605–12.
Hughes RA, Swan AV, van Doorn PA. Intravenous immunoglobulin for Guillain–Barre syndrome. Cochrane Database Syst Rev. 2014;(9):CD002063.
Raphaël JC, Chevret S, Hughes RA, Annane D. Plasma exchange for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2012;(7):CD001798.
Durbin CG Jr. Tracheostomy: why, when, and how? Respir Care. 2010;55(8):1056–68.
Trouillet JL, Luyt CE, Guiguet M, et al. Early percutaneous tracheotomy versus prolonged intubation of mechanically ventilated patients after cardiac surgery: a randomized trial. Ann Intern Med. 2011;154(6):373–83.
Wijdicks EF, Lawn ND, Fletcher DD. Tracheostomy scars in Guillain–Barre syndrome: a reason for concern? J Neurol. 2001;248(6):527–8.
van Koningsveld R, Steyerberg EW, Hughes RA, Swan AV, van Doorn PA, Jacobs BC. A clinical prognostic scoring system for Guillain–Barre syndrome. Lancet Neurol. 2007;6(7):589–94.
Walgaard C, Lingsma HF, Ruts L, et al. Prediction of respiratory insufficiency in Guillain–Barre syndrome. Ann Neurol. 2010;67(6):781–7.
Walgaard C, Lingsma HF, Ruts L, van Doorn PA, Steyerberg EW, Jacobs BC. Early recognition of poor prognosis in Guillain–Barre syndrome. Neurology. 2011;76(11):968–75.
Lawn ND, Wijdicks EF. Post-intubation pulmonary function test in Guillain–Barre syndrome. Muscle Nerve. 2000;23(4):613–6.
Fourrier F, Robriquet L, Hurtevent JF, Spagnolo S. A simple functional marker to predict the need for prolonged mechanical ventilation in patients with Guillain–Barre syndrome. Crit Care. 2011;15(1):R65.
van der Meche FG, Schmitz PI. A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain–Barre syndrome. Dutch Guillain–Barre Study Group. N Engl J Med. 1992;326(17):1123–9.
van Koningsveld R, Schmitz PI, Meche FG, Visser LH, Meulstee J, van Doorn PA. Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain–Barre syndrome: randomised trial. Lancet. 2004;363(9404):192–6.
Ruts L, Drenthen J, Jongen JL, et al. Pain in Guillain–Barre syndrome: a long-term follow-up study. Neurology. 2010;75(16):1439–47.
Treatment of Guillain–Barre syndrome with high-dose immune globulins combined with methylprednisolone: a pilot study. The Dutch Guillain–Barre Study Group. Ann Neurol. 1994;35(6):749–52.
Garssen MP, van Koningsveld R, van Doorn PA, et al. Treatment of Guillain–Barre syndrome with mycophenolate mofetil: a pilot study. J Neurol Neurosurg Psychiatry. 2007;78(9):1012–3.
Hadden RD, Cornblath DR, Hughes RA, et al. Electrophysiological classification of Guillain–Barre syndrome: clinical associations and outcome. Plasma Exchange/Sandoglobulin Guillain–Barre Syndrome Trial Group. Ann Neurol. 1998;44(5):780–8.
Lawn ND, Wijdicks EF. Tracheostomy in Guillain–Barre syndrome. Muscle Nerve. 1999;22(8):1058–62.
Durand MC, Porcher R, Orlikowski D, et al. Clinical and electrophysiological predictors of respiratory failure in Guillain–Barre syndrome: a prospective study. Lancet Neurol. 2006;5(12):1021–8.
Kaida K, Kusunoki S, Kanzaki M, Kamakura K, Motoyoshi K, Kanazawa I. Anti-GQ1b antibody as a factor predictive of mechanical ventilation in Guillain–Barre syndrome. Neurology. 2004;62(5):821–4.
Funakoshi K, Kuwabara S, Odaka M, Hirata K, Yuki N. Clinical predictors of mechanical ventilation in Fisher/Guillain–Barre overlap syndrome. J Neurol Neurosurg Psychiatry. 2009;80(1):60–4.
Bos Eyssen ME, van Doorn PA, Jacobs BC, et al. Selective digestive tract decontamination decreases time on ventilator in Guillain–Barre syndrome. Neurocrit Care. 2011;15(1):128–33.
Plummer AL, Gracey DR. Consensus conference on artificial airways in patients receiving mechanical ventilation. Chest. 1989;96(1):178–80.
Nieszkowska A, Combes A, Luyt CE, et al. Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients. Crit Care Med. 2005;33(11):2527–33.
Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med. 2004;32(8):1689–94.
Terragni PP, Antonelli M, Fumagalli R, et al. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA. 2010;303(15):1483–9.
Wang F, Wu Y, Bo L, et al. The timing of tracheotomy in critically ill patients undergoing mechanical ventilation: a systematic review and meta-analysis of randomized controlled trials. Chest. 2011;140(6):1456–65.