title: Clinical presentations as predictors of prolonged mechanical ventilation in Guillain-Barré syndrome in an institution with limited medical resources.
abstract: BACKGROUND
  Severe Guillain-Barré syndrome (GBS) causes ventilatory insufficiency and the need for prolonged artificial ventilation. Under circumstances where medical care for patients with severe GBS is required in a resource-limited institution, identifying initial clinical presentations in GBS patients that can predict respiratory insufficiency and the need for prolonged mechanical ventilation (> 15 days) may be helpful for advanced care planning.
  
  
  METHODS
  The medical records of patients diagnosed with GBS in a tertiary care and medical teaching hospital from January 2001 to December 2010 were retrospectively reviewed. The demographic data and clinical presentations of the patients were summarised using descriptive statistics. Clinical predictors of respiratory insufficiency and the need for prolonged mechanical ventilation (> 15 days) were identified using univariate logistic regression analysis.
  
  
  RESULTS
  A total of 55 patients with GBS were included in this study. Mechanical ventilation was needed in 28 (50.9%) patients. Significant clinical predictors for respiratory insufficiency were bulbar muscle weakness (odds ratio [OR] 5.08, 95% confidence interval [CI] 1.31-21.60, p = 0.007) and time to peak limb weakness ≤ 5 days (OR 0.75, 95% CI 0.62-0.91, p < 0.001). Bulbar muscle weakness (p = 0.006) and time to peak limb weakness ≤ 5 days (p < 0.001) were also found to be significantly associated with the need for prolonged mechanical ventilation (> 15 days).
  
  
  CONCLUSIONS
  Bulbar weakness and time to peak limb weakness ≤ 5 days were able to predict respiratory insufficiency and the need for prolonged mechanical ventilation in patients with GBS.
authors.affiliation: Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Umarudee
authors.initials: U
authors.lastname: Toamad
authors.affiliation: Occupational Health Unit, Department of Community Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Chanon
authors.initials: C
authors.lastname: Kongkamol
authors.affiliation: Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Suwanna
authors.initials: S
authors.lastname: Setthawatcharawanich
authors.affiliation: Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Kitti
authors.initials: K
authors.lastname: Limapichat
authors.affiliation: Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Kanitpong
authors.initials: K
authors.lastname: Phabphal
authors.affiliation: Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Pornchai
authors.initials: P
authors.lastname: Sathirapanya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D020275:Guillain-Barre Syndrome / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000150:complications; D016017:Odds Ratio; D012044:Regression Analysis; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: Guillain-Barré syndrome; mechanical ventilation; respiratory failure