Comparison of ICU outcome of mechanically ventilated gbs patients receiving intravenous immunuglobulin or plasma exchange in a neuro-icu of Bangladesh

Abstract

Introduction: Intravenous immunoglobulin (IVIG) and plasma exchanges (PLEX) are the standard therapy for Guillain-Barré syndrome (GBS) patients. Objectives/Aims: The aim of the study was to compare ICU outcome of mechanically ventilated (MV) GBS patients treated with IVIG and PLEX. Methods: This prospective cohort study was conducted in the ICU of Department of Critical Care at National Institute of Neurosciences & Hospital, Dhaka, Bangladesh from January 2017 to December 2018 for a period of 1 year. All GBS patients under MV treated with either IVIG or plasma exchange were selected as study population who were divided into group A with IVIG (0.4 g/kg/day for 5 days) and group B with PLEX- 5 sessions for 10 days in every alternate day. The outcome variables were duration of MV, need for tracheostomy and duration of ICU stay. The follow up was done at 6 months. Results: Seventy-four patients (58 in group A and 16 in group B) were enrolled. The mean age was 30.31±15.47 years in Group A and 30.88±12.09 years in Group B, with a male predominance (78.4%). Electrophysiological study reavled acute inflammatory demyelinating polyradiculoneuropathy (AIDP) in 19 (25.7%) patients, acute motor axonal neuropathy (AMAN) in 46 (62.2%) patients, acute motor-sensory axonal neuropathy (AMSAN) was 3 (4.1%). The mean length of ICU stay was 23.66±19.18 days and 60.12 ±38.79 days in Group A and Group respectively (p = 0.02). The mean duration of MV was 21.12±16.55 days and 51.12 ±35.31 days in Group A and Group respectively (P=.04) and the need for tracheostomy (p=.001) was less in Group A than Group B. Conclusion: This study revealed a significant difference for the duration of MV and ICU stay in IVIG group compared to PLEX.