Guillain-Barre Syndrome: A Retrospective Study in the Department of Critical Care of Pediatrics in a Tertiary Care Hospital

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The cross sectional, retrospective descriptive study was done to document the number of GBS patient needed critical care, pattern of their presentation, management, complications and outcome in Pediatric intensive care unit (PICU) of Dhaka Shishu Hospital from January 2011 to December 2013. Data was collected from the admission record file in PICU. A total of 30 patients aged 1 to 15 years diagnosed as Cruillain-Barre syndrome were included in the study. Detailed history, clinical examination, investigations, treatment modality and outcome for GBS was recorded including age, gender, cause of transfer to ICU, antecedent illness, respiratory muscles and bulbar paralysis, cranial nerve involvement, sensory and autonomic dysfunction, CSF study. During the study period, a total of 214 patients were diagnosed as GBS in the hospital and 30 patients were transferred to PICU. Among those, 29 (96.7%) patient were classical GBS and 1 (3.3%) relapse GBS. Common cause of transfer to ICU was respiratory muscle and bulbar paralysis (27, 90%). Most patients were in the age range of 1-5 years (20, 66.7%). Autonomic dysfunction was present in 16 (53.3%) cases and cranial nerve involvement in 1 (3.3%) cases. In 22 (73.3%) patients the antecedent event was respiratory infections and diarrhea in 2 (20%) cases. CSF study was done in 25 (83.3%) patients and albuminocytological dissociation was found in 19 (76%) cases. Total 26 (86.7%) patients were treated with IVIG and rest were with steroid (4, 13.3%). 12 (40%) patients needed mechanical ventilation, respiratory muscle paralysis (9, 75%) was the commonest indication. Most common complication during treatment was aspiration pneumonia (14, 46.7%). Twenty-three patients (76.7%) were improved and transfer-red to ward, 7 (23.3%) expired. Bulbar involvement with respiratory failure is the most common indication of admission in ICU. WIG is the effective treatment modality and need of mechanical ventilation indicates poor outcome.