Intensive Care and Treatment of Severe Guillain-Barré Syndrome.

Pei Shang,Wei Wu,Jiachun Feng,Hong-Liang Zhang

doi:10.3389/fphar.2021.608130

Abstract

Guillain–Barré syndrome (GBS) is an acute polyneuropathy mostly characterized by acute flaccid paralysis with or without sensory/autonomous nerve dysfunction. Current immuno therapies including intravenous immunoglobulin (IVIg), plasma exchange (PE), and newly developed biological drugs benefit patients by alleviating hyperreactive immune responses. Up to 30% of patients develop respiratory failure during hospitalization and require mechanical ventilation and intensive care. Immunotherapies, mechanical ventilation, supportive care, and complication management during the intensive care unit (ICU) stay are equally emphasized. The most important aspect of intensive care and treatment of severe GBS, that is, mechanical ventilation, has been extensively reviewed elsewhere. In contrast to immunotherapies, care and treatment of GBS in the ICU setting are largely empirical. In this review, we intend to stress the importance of intensive care and treatment, other than mechanical ventilation in patients with severe GBS. We summarize the up-to-date knowledge of pharmacological therapies and ICU management of patients with severe GBS. We aim to answer some key clinical questions related to the management of severe GBS patients including but not limited to: Is IVIg better than PE or vice versa? Whether combinations of immune therapies benefit more? How about the emerging therapies promising for GBS? When to perform tracheal intubation or tracheostomy? How to provide multidisciplinary supportive care for severe cases? How to avert life-threatening complications in severe cases?

Highlights

Guillain–Barré syndrome (GBS) is recognized as a paralytic peripheral neuropathy with an annual incidence of 0.81–1.89 cases per 100,000 persons worldwide (Benedetti et al, 2019)
Despite research displaying the superiority of intravenous immunoglobulin (IVIg) to plasma exchange (PE) in mechanical ventilation (MV)-dependent GBS patients (Charra et al, 2014), the evidence quality is very low
No evidence supports the combinational use of IVIg and PE for severe GBS patients as well

Summary

Introduction

Guillain–Barré syndrome (GBS) is recognized as a paralytic peripheral neuropathy with an annual incidence of 0.81–1.89 cases (median, 1.11) per 100,000 persons worldwide (Benedetti et al, 2019). The in-hospital mortality rate of GBS is approximately 2.6–2.8%, and risk factors include severity of weakness at entry, time to peak disability, mechanical ventilation (MV), old age, and pulmonary and cardiac complications (Alshekhlee et al, 2009; Van Den Berg et al, 2013). Prognostic factors of a poor prognosis mainly include old age, acute hospital stay, prolonged MV and intensive care unit (ICU) stay, and insufficient rehabilitation after discharge Intensive Care of GBS et al, 2018). Patients’ recovery benefits from high-intensity multidisciplinary ambulatory rehabilitation even up to 12 months since onset, highlighting the importance of early and persistent rehabilitation (Khan and Amatya, 2012)

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Conclusion