title: Clinical predictors of mechanical ventilation in Guillain-Barré syndrome.
abstract: BACKGROUND
  Patients with Guillain-Barré syndrome (GBS) require assisted ventilation frequently. However, no single factor can predict ventilator requirement.
  
  
  OBJECTIVE
  To identify clinical variables which could predict the need for mechanical ventilation in GBS.
  
  
  METHODS
  Tertiary hospital-based retrospective and prospective study.
  
  
  METHODS
  One hundred and thirty-eight GBS patients studied were divided into two groups ventilated (Group 1) and non-ventilated (Group 2). Parameters assessed included age, gender, associated illness(es), antecedent events, first symptom at onset, time from onset to bulbar involvement, confinement to bed and peak disability, upper limb power and reflexes at nadir, presence of facial weakness, neck muscle weakness and autonomic dysfunction.
  
  
  METHODS
  Multivariate predictors of ventilation were assessed using logistic regression analysis.
  
  
  RESULTS
  There were 53 patients in Group 1 and 85 in Group 2. The mean age in the two groups was comparable. On bivariate analysis, simultaneous weakness of upper (UL) and lower (LL) limbs as the initial symptom (P<0.001); UL power less than Grade 3/5 at nadir (P<0.001); presence of neck and bulbar weakness (P<0.001); shorter duration from onset to bulbar weakness and confinement to bed (P=0.001) and bilateral facial involvement (P<0.01) were more frequently associated with the need for ventilation. Preserved reflexes in UL at nadir was significantly associated with absence of the need for mechanical ventilation (P<0.01). On multivariate analysis, factors independently associated with the need for mechanical ventilation included simultaneous motor weakness in UL and LL as the initial symptom (P=0.02), UL power<3/5 (Medical Research Council grade) at nadir (P=0.013) and presence of bulbar weakness (P<0.001). Preserved reflexes in the UL at nadir was independently associated with a lesser need for ventilation (P=0.001).
  
  
  CONCLUSIONS
  Comprehensive assessment of clinical features may predict the need for mechanical ventilation in patients of GBS.
authors.affiliation: Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. drbirinder06@yahoo.co.in
authors.forename: Birinder S
authors.initials: BS
authors.lastname: Paul
authors.forename: Rohit
authors.initials: R
authors.lastname: Bhatia
authors.forename: Kameshwar
authors.initials: K
authors.lastname: Prasad
authors.forename: M V
authors.initials: MV
authors.lastname: Padma
authors.forename: Manjari
authors.initials: M
authors.lastname: Tripathi
authors.forename: M B
authors.initials: MB
authors.lastname: Singh
mesh_terms: D000328:Adult; D005260:Female; D020275:Guillain-Barre Syndrome / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000453:epidemiology* / Q000628:therapy*; D012189:Retrospective Studies; D055815:Young Adult