title: Swallowing and swallowing-breathing interaction as predictors of intubation in Guillain-Barré syndrome.
abstract: Bulbar weakness and respiratory impairment have been associated with increased morbidity in retrospective studies of Guillain-Barré syndrome (GBS) patients. The aim of this study was to prospectively explore the relationship between subclinical swallowing impairment, respiratory function parameters, the necessity to intubate patients and the development of early postintubation pneumonia in patients with GBS in the intensive care unit (ICU).
  
  
  
  Respiratory, swallowing, and tongue strength parameters were measured in 30 consecutive adults (51.7 ± 18.1 years old), hospitalized for GBS in the ICU of a teaching hospital. Twenty healthy volunteers were recruited as a control group. The primary outcomes were intubation and pneumonia during the ICU stay.
  
  
  
  Nineteen patients (65.5%) had piecemeal swallowing, and 19 (65.5%) had impaired breathing-swallowing interaction, of which, respectively, 47.4% and 52.6% had a clinically apparent swallowing impairment. Swallowing impairment was associated with lower values of respiratory function, but not with peripheral motor weakness. Tongue protrusion strength was correlated with respiratory parameters and swallowing impairment. Ten patients were intubated and six developed pneumonia. Age, BMI, severe axial involvement, respiratory parameters (vital capacity and respiratory muscle strength), tongue protrusion strength, and clinical swallowing impairment were predictors of intubation.
  
  
  
  Swallowing impairment was present early after ICU admission in over 80% of patients and was an important predictor of intubation. A systematic clinical evaluation of swallowing should be carried out, eventually combined with an evaluation of tongue protrusion strength, along with the usual assessment of neurological and respiratory function, to determine the severity of the GBS.
authors.affiliation: Service de Réanimation médicale et unité de ventilation à domicile Hôpital Raymond Poincaré Garches France.
authors.forename: Adam
authors.initials: A
authors.lastname: Ogna
authors.affiliation: Service de Physiologie-Explorations Fonctionnelles Hôpital Raymond Poincaré Garches France.
authors.forename: Helene
authors.initials: H
authors.lastname: Prigent
authors.affiliation: INSERM CIC 14.29 Hôpital Raymond Poincaré Garches France.
authors.forename: Michele
authors.initials: M
authors.lastname: Lejaille
authors.affiliation: Unité de Recherche Clinique Paris Ouest Département d'Information Hospitalière et de Santé Publique Hôpital Ambroise-Paré Boulogne France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Samb
authors.affiliation: Service de Réanimation médicale et unité de ventilation à domicile Hôpital Raymond Poincaré Garches France.
authors.forename: Tarek
authors.initials: T
authors.lastname: Sharshar
authors.affiliation: Service de Réanimation médicale et unité de ventilation à domicile Hôpital Raymond Poincaré Garches France.
authors.forename: Djillali
authors.initials: D
authors.lastname: Annane
authors.affiliation: Service de Physiologie-Explorations Fonctionnelles Hôpital Raymond Poincaré Garches France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Lofaso
authors.affiliation: Service de Réanimation médicale et unité de ventilation à domicile Hôpital Raymond Poincaré Garches France; INSERM CIC 14.29 Hôpital Raymond Poincaré Garches France.
authors.forename: David
authors.initials: D
authors.lastname: Orlikowski
mesh_terms: D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D005260:Female; D020275:Guillain-Barre Syndrome / Q000150:complications* / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D007440:Intubation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology*; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy*
keywords: Guillain‐Barré syndrome; ICU; dysphagia; intubation; tongue strength; vital capacity