Physiological changes during and outcome following ‘filtration’ based continuous plasma exchange in Guillain Barre Syndrome

Abstract

Background Therapeutic plasma exchange is an extracorporeal blood purification technique designed for the removal of large molecular weight substances from plasma. It is the first line treatment in Guillain Barre Syndrome (GBS) improving outcome. Aim To study the outcome in GBS following therapeutic plasma exchange (TPE) utilizing a modified, cost saving, filtration based plasma exchange technique. Methodology and findings Consenting patients with GBS underwent TPE using a modified regime of two 48 h sessions as a cost saving strategy. The second session was conducted only if there was inadequate benefit from the first session. Nerve conduction studies confirmed the diagnosis of GBS. Results Fifteen patients were studied. One died following a cerebro-vascular accident. Of the remaining 14 patients, five showed improvement in muscle power at least by one grade in one limb within 48 h of plasma exchange. The duration of intensive care unit stay was 10 (median) days (range 4–66). Nine required mechanical ventilation for (median) 15 days (range 4–50). The mean 24 h urine output increased significantly since the initiation of plasma exchange was 6262.92 ml (SD = 8867.24, P = 0.032) at 48 h and 6474.92 ml at 72 h (SD = 6364.81, P = 0.003). The pulse rates and blood pressures were not significantly different before and after plasma exchange. Complications attributable to plasma exchange were mild; a hypersensitivity reaction and a tendency to ooze from a puncture site. Conclusion ‘Continuous’ TPE, the modified cost saving technique seems to improve the outcome of patients with Guillain Barre Syndrome with minimal complications.