Early predictors of mechanical ventilation in Guillain-Barré syndrome.
OBJECTIVE
Although mechanical ventilation is required in 30% of patients with Guillain-Barré syndrome, early predictors of this treatment remain unknown.


METHODS
Analysis of two cohorts of patients enrolled in two multicenter randomized clinical trials.


METHODS
French intensive care and neurologic units.


METHODS
Demographic, neurologic, and biologic data; vital capacity; and time of onset, admission, and endotracheal mechanical ventilation were collected.


RESULTS
Amid 722 consecutive adults not ventilated at admission, endotracheal mechanical ventilation was required in 313 (43%) patients. Multivariate analyses identified six predictors of endotracheal mechanical ventilation: time from onset to admission of <7 days (odds ratio, 2.51), inability to cough (odds ratio, 9.09), inability to stand (odds ratio, 2.53), inability to lift the elbows (odds ratio, 2.99) or head (odds ratio, 4.34), and liver enzyme increases (odds ratio, 2.09). In the 196 (27%) patients whose vital capacity was measured, time from onset to admission of <7 days (odds ratio, 5.00), inability to lift the head (odds ratio, 5.00), and vital capacity <60% (odds ratio, 2.86) predicted endotracheal mechanical ventilation.


CONCLUSIONS
Patients with at least one of these predictors should be monitored in an intensive care unit. Mechanical ventilation was required in >85% of patients with at least four predictors from the first multivariate model and in 85% of patients with all three predictors from the second multivariate model. In these patients at high risk of respiratory failure, the value of early mechanical ventilation may deserve investigation.
Sharshar
Tarek
T
Medical Intensive Care Unit, Raymond Poincaré Teaching Hospital, Garches, France.
Chevret
Sylvie
S
Bourdain
Frederic
F
Raphaël
Jean-Claude
JC
D000704:Analysis of Variance; D005260:Female; D020275:Guillain-Barre Syndrome / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D006305:Health Status Indicators; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010951:Plasma Exchange; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D012307:Risk Factors; D014797:Vital Capacity