From the Guidelines
Intubation in Guillain-Barré Syndrome (GBS) is indicated when there are signs of respiratory distress, including breathlessness at rest or during talking, inability to count to 15 in a single breath, use of accessory respiratory muscles, increased respiratory or heart rate, vital capacity <15–20 ml/kg or <1 l, or abnormal arterial blood gas or pulse oximetry measurements, as stated in the 2019 study published in Nature Reviews Neurology 1.
Indications for Intubation
The primary indicators for intubation in GBS patients include:
- Vital capacity less than 15-20 mL/kg
- Inability to count to 15 in a single breath
- Use of accessory respiratory muscles
- Increased respiratory or heart rate
- Abnormal arterial blood gas or pulse oximetry measurements
Clinical Assessment
Clinical signs that warrant immediate intubation include:
- Dyspnea
- Tachypnea
- Paradoxical breathing
- Inability to clear secretions
- Bulbar weakness affecting swallowing and airway protection
Risk Factors for Prolonged Mechanical Ventilation
Patients with the following risk factors should be considered for early tracheostomy:
- Inability to lift the arms from the bed at 1 week after intubation
- Axonal subtype or unexcitable nerves in electrophysiological studies The Erasmus GBS Respiratory Insufficiency Score (EGRIS) prognostic tool can be used to calculate the probability of requiring ventilation within 1 week of assessment, as mentioned in the 2019 study 1. However, it is essential to note that this tool may not be applicable in all populations, as highlighted in the 2021 study published in Nature Reviews Neurology 1.
From the Research
Indications of Intubation in GBS
The decision to intubate a patient with Guillain-Barré syndrome (GBS) is critical and depends on several clinical factors. Some of the key indications include:
- Rapid disease progression 2
- Bulbar dysfunction 2, 3
- Bilateral facial weakness 2
- Dysautonomia 2
- Vital capacity of less than 20 mL/kg 2 or below 60% of predicted value 4
- Maximal inspiratory pressure less than 30 cm H(2)O 2
- Maximal expiratory pressure less than 40 cm H(2)O 2
- Reduction of more than 30% in vital capacity, maximal inspiratory pressure, or maximal expiratory pressure 2
Respiratory Function Tests
Respiratory function tests, such as vital capacity and maximal inspiratory pressure, are useful in assessing the need for intubation in GBS patients. However, the relationship between these tests and the need for intubation is not always clear-cut. Some studies suggest that vital capacity is a more reliable indicator of respiratory muscle failure than maximal inspiratory pressure 5. Others propose that a vital capacity below 60% of predicted value is associated with the need for intubation and ventilation 4.
Clinical Judgment
Ultimately, the decision to intubate a GBS patient depends on clinical judgment, taking into account the patient's overall condition, disease progression, and respiratory function. Early intubation may be necessary to prevent life-threatening complications, such as respiratory failure and aspiration pneumonia 3. Non-invasive ventilation may be considered in some cases, particularly if the patient has no bulbar weakness 6.