title: Predictive factors and long-term outcome of respiratory failure after Guillain-Barré syndrome.
abstract: OBJECTIVE
  To analyze predictive factors and long-term recovery in patients with Guillain-Barré syndrome (GBS) who are in need of mechanical ventilation.
  
  
  METHODS
  In this 15-year retrospective study, 77 adult patients were identified with GBS. A comparison was made between the clinical data from patients who required mechanical ventilation and those who did not. Furthermore, the therapeutic outcomes of those 25 patients in need of mechanical ventilation during hospitalization at 1 year were determined using a modified Barthel index. A score below 12 was defined as a poor outcome, whereas a score of 12 or more was good.
  
  
  RESULTS
  The study revealed 32% of patients (25/77) in need of respiratory support during hospitalization. At a follow-up of 1 year among the 25 ventilated patients, 7 patients (28%) had normal or minor signs and symptoms, 6 had unassisted gait, 3 had assisted gait, 6 were wheelchair- or bed-bound, and 3 died. The cause of death was septicemia with septic shock in all 3 cases. Factors that predict respiratory failure in the study GBS patients were disability grade on admission and areflexia. Those ventilated patients who had low maximal inspiratory pressure (PImax) (<14.5 cmH2O) and maximal expiratory pressure (PEmax) (<13.5 cmH2O) values at the time of intubation and the presence of complications after mechanical ventilation inevitably had worse outcomes than those who had not.
  
  
  CONCLUSIONS
  If low values of PImax and PEmax at intubation were detected, aggressive respiratory management, which might include tracheostomy to allow more efficient bronchial clearing, and prevention of complications caused by prolonged course of mechanical ventilation are essential to maximize the potential for survival.
authors.affiliation: Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung, National Sun Yat-Sen University, Kaohsiung, Taiwan.
authors.forename: Ben-Chung
authors.initials: BC
authors.lastname: Cheng
authors.forename: Wen-Neng
authors.initials: WN
authors.lastname: Chang
authors.forename: Chen-Sheng
authors.initials: CS
authors.lastname: Chang
authors.forename: Nai-Wen
authors.initials: NW
authors.lastname: Tsai
authors.forename: Chin-Jung
authors.initials: CJ
authors.lastname: Chang
authors.forename: Pi-Lien
authors.initials: PL
authors.lastname: Hung
authors.forename: Kuo-Wei
authors.initials: KW
authors.lastname: Wang
authors.forename: Jin-Bor
authors.initials: JB
authors.lastname: Chen
authors.forename: Chien-Yu
authors.initials: CY
authors.lastname: Tsai
authors.forename: Kuo-Tai
authors.initials: KT
authors.lastname: Hsu
authors.forename: Hsueh-Wen
authors.initials: HW
authors.lastname: Chang
authors.forename: Cheng-Hsien
authors.initials: CH
authors.lastname: Lu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D020275:Guillain-Barre Syndrome / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome