Parasternal EMG assessment in patients with severe Guillain-Barré Syndrome weaning from mechanical ventilation

Abstract

<b>Introduction:</b> Patients with severe Guillain-Barré Syndrome (pwGBS) suffer from respiratory insufficiency requiring prolonged invasive mechanical ventilation (IMV).&nbsp;With time, respiratory rehabilitation and nerve recovery, most can be weaned.&nbsp;We assessed parasternal electromyogram (EMGpara) in a cohort of pwGBS transferred to a weaning centre as a tool to predict respiratory recovery and liberation from IMV. Method: A prospective case series cohort of pwGBS were enrolled.&nbsp;We measured EMGpara in unsedated patients 2-4 weeks before and after IMV liberation during self-ventilation trials with tidal breathing and inspiratory capacity manoeuvres.&nbsp;Maximal inspiratory pressure (MIP) was measured, where possible, to assess respiratory muscle recovery. <b>Results:</b> 6 pwGBS recruited (3 females; mean age: 64+/−10.2; BMI: 26.6+/−3.97), 5 weaned from IMV (median days on IMV:163; range: 85-200).&nbsp;&nbsp;In pwGBS liberated from IMV, mean tidal EMGpara ranged from 7.60µV+/−1.27 to 7.94 +/− 1.61 with no longitudinal change.&nbsp;Respiratory muscle strength improved (n=4; range pre: 19 to 28cmH2O; post: 37 to 61).&nbsp;Two distinct weaning patterns observed with 2 pwGBS showing improvement in respiratory rate (starting rate &gt;20/min) corresponding to increase in maximal EMGpara; 3 pwGBS had static maximal EMGpara and respiratory rate.&nbsp;In patient who was not weaned (due to bilateral vocal cord palsy) tidal EMGpara (max 13.4µV) increased during recovery phase with persistent high respiratory rate. <b>Conclusion:</b> Improved respiratory rate during self-ventilation trials was strongly associated with successful weaning in pwGBS.&nbsp;Tidal breathing EMGpara was not a predictor of for successful weaning.