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López-Hernández JC, Jorge de Saráchaga A, Briseño-Godínez ME, May-Mas RN, Bazán-Rodríguez L, León-Manriquez E, Cruz-Pérez J, Becerra-Hernández I, Vargas-Cañas ES. Deltoid muscle strength and autonomic dysfunction as independent risk factors for invasive mechanical ventilation in patients with Guillain-Barré syndrome. Int J Neurosci 2023; 133:1403-1410. [PMID: 35633066 DOI: 10.1080/00207454.2022.2082963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 05/20/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Almost a third of patients with Guillain-Barré Syndrome (GBS) require mechanical ventilation, increasing mortality by 15-30% and proving poor functional outcomes. The Erasmus GBS Respiratory Insufficiency Score (EGRIS) is the most frequently used scale to assess probability of respiratory insufficiency within the first week of admission. We aim to determine other clinical and electrophysiological prognostic factors for invasive mechanical ventilation (IMV) in patients with GBS. MATERIAL AND METHODS A cross-sectional ambispective cohort study was carried out in a referral center in Mexico City, from January 2015 to December 2019. Baseline demographics, MRC score, Hughes scale, EGRIS, dysautonomia and nerve conduction studies were performed on admission in GBS patients that required IMV. A multivariable analysis for IMV and a survival analysis for independent walk in prolonged-IMV (>14 days) were performed. RESULTS Forty-nine (32%) out of 153 GBS patients required IMV. Statistically significant prognostic factors in multivariable analysis were deltoid muscle strength ≤2 [OR 7.1 (1.6-31.1)], EGRIS [OR 2.5 (1.3-4.6)] and autonomic dysfunction [OR 6.6 (2.0-22.0)]. Electrodecrement <1 mV in the compound muscle action potential (CMAP) of distal motor median nerve was more prevalent in prolonged-IMV patients (44.8% vs. 21%, p = .049). A significant minor prevalence of prolonged-IMV patients regain independent walk at 6 months using the Kaplan-Meier method (log rank test p < .001). CONCLUSIONS We provide new specific clinical (deltoid muscle strength and autonomic dysfunction) and electrophysiological variables to discriminate GBS patients that will require IMV.
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Affiliation(s)
| | - Adib Jorge de Saráchaga
- Neuromuscular Disorders Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - Raúl Nathanael May-Mas
- Neuromuscular Disorders Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Lisette Bazán-Rodríguez
- Neuromuscular Disorders Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Elizabeth León-Manriquez
- Neuromuscular Disorders Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Jocelyn Cruz-Pérez
- Neurocritical Care Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Israel Becerra-Hernández
- Neurocritical Care Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Edwin Steven Vargas-Cañas
- Neuromuscular Disorders Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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Breville G, Sukockiene E, Vargas MI, Lascano AM. Emerging biomarkers to predict clinical outcomes in Guillain-Barré syndrome. Expert Rev Neurother 2023; 23:1201-1215. [PMID: 37902064 DOI: 10.1080/14737175.2023.2273386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/17/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is an immune-mediated poly(radiculo)neuropathy with a variable clinical outcome. Identifying patients who are at risk of suffering from long-term disabilities is a great challenge. Biomarkers are useful to confirm diagnosis, monitor disease progression, and predict outcome. AREAS COVERED The authors provide an overview of the diagnostic and prognostic biomarkers for GBS, which are useful for establishing early treatment strategies and follow-up care plans. EXPERT OPINION Detecting patients at risk of developing a severe outcome may improve management of disease progression and limit potential complications. Several clinical factors are associated with poor prognosis: higher age, presence of diarrhea within 4 weeks of symptom onset, rapid and severe weakness progression, dysautonomia, decreased vital capacity and facial, bulbar, and neck weakness. Biological, neurophysiological and imaging measures of unfavorable outcome include multiple anti-ganglioside antibodies elevation, increased serum and CSF neurofilaments light (NfL) and heavy chain, decreased NfL CSF/serum ratio, hypoalbuminemia, nerve conduction study with early signs of demyelination or axonal loss and enlargement of nerve cross-sectional area on ultrasound. Depicting prognostic biomarkers aims at predicting short-term mortality and need for cardio-pulmonary support, long-term patient functional outcome, guiding treatment decisions and monitoring therapeutic responses in future clinical trials.
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Affiliation(s)
- Gautier Breville
- Neurology Division, Neuroscience Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Egle Sukockiene
- Neurology Division, Neuroscience Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Maria Isabel Vargas
- Neuroradiology Division, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Agustina M Lascano
- Neurology Division, Neuroscience Department, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Naresh K, Roy A, Srivastava S, Premkumar P, Nair A, Mani AM, Shaikh A, Thirumal PA, Sivadasan A, Mathew V, Premkumar PS, Benjamin R. Sensitivity and specificity of phrenic nerve electrophysiology to predict mechanical ventilation in the Guillain-Barré syndrome. Muscle Nerve 2023. [PMID: 37300403 DOI: 10.1002/mus.27918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION/AIMS In Guillain-Barré syndrome (GBS), the sensitivity and specificity of phrenic compound muscle action potential (CMAP) measurements to predict endotracheal mechanical ventilation are unknown. Hence, we sought to estimate sensitivity and specificity. METHODS We performed a 10-year retrospective analysis of adult GBS patients from our single-center laboratory database (2009 to 2019). The phrenic nerve amplitudes and latencies before ventilation were recorded along with other clinical and demographic features. Receiver operating curve (ROC) analysis with area under the curve (AUC) was used to determine the sensitivity and specificity with 95% confidence interval (CI) for phrenic amplitudes and latencies in predicting the need for mechanical ventilation. RESULTS Two hundred five phrenic nerves were analyzed in 105 patients. The mean age was 46.1 ± 16.2 years, with 60% of them being male. Fourteen patients (13.3%) required mechanical ventilation. The average phrenic amplitudes were lower in the ventilated group (P = .003), but average latencies did not differ (P = .133). ROC analysis confirmed that phrenic amplitudes could predict respiratory failure (AUC = 0.76; 95% CI, 0.61 to 0.91; P < .002), but phrenic latencies could not (AUC = 0.60; 95% CI, 0.46 to 0.73; P = .256). The best threshold for amplitude was ≥0.6 mV, with sensitivity, specificity, and positive and negative predictive values of 85.7%, 58.2%, 24.0%, and 96.4%, respectively. DISCUSSION Our study suggests that phrenic CMAP amplitudes can predict the need for mechanical ventilation in GBS. In contrast, phrenic CMAP latencies are not reliable. The high negative predictive value of phrenic CMAP amplitudes ≥0.6 mV can preclude mechanical ventilation, making these a useful adjunct to clinical decision-making.
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Affiliation(s)
- Kancha Naresh
- Neurology, Department of Neurosciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anupama Roy
- Neuro-Electrophysiology Laboratory, Department of Neurosciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Shreya Srivastava
- Neuro-Electrophysiology Laboratory, Department of Neurosciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Paul Premkumar
- Neuro-Electrophysiology Laboratory, Department of Neurosciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Aditya Nair
- Neurology, Department of Neurosciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Arun Mathai Mani
- Neurology, Department of Neurosciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Atif Shaikh
- Neurology, Department of Neurosciences, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Ajith Sivadasan
- Neurology, Department of Neurosciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vivek Mathew
- Neurology, Department of Neurosciences, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Rohit Benjamin
- Neurology, Department of Neurosciences, Christian Medical College, Vellore, Tamil Nadu, India
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Madike R, Muecke T, Dishnica N, Zhu L, Tan S, Kovoor J, Stretton B, Gupta A, Harroud A, Bersten A, Schultz D, Bacchi S. A vital parameter? Systematic review of spirometry in evaluation for intensive care unit admission and intubation and ventilation for Guillain-Barré syndrome. J Clin Neurosci 2023; 113:13-19. [PMID: 37146475 DOI: 10.1016/j.jocn.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/09/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Patients with Guillain-Barré syndrome (GBS) may require intensive care unit (ICU) admission for intubation and ventilation (I + V). The means to predict which patients will require I + V include spirometry measures. The aims of this study were to determine, for adult patients with GBS, how effectively different spirometry parameter thresholds predict the need for ICU admission and the requirement for I + V; and what effects these different parameter thresholds have on GBS patient outcomes. METHOD A systematic review was conducted of the databases PubMed, EMBASE, and Cochrane library in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The systematic review was registered prospectively on PROSPERO. RESULTS Initial searches returned 1011 results, of which 8 fulfilled inclusion criteria. All included studies were observational in nature. Multiple studies suggest that a vital capacity below 60% of predicted value on admission is associated with the need for eventual I + V. No included studies evaluated peak expiratory flow rate, or interventions with different thresholds for ICU or I + V. CONCLUSIONS There is a relationship between vital capacity and the need for I + V. However, there is limited evidence supporting specific thresholds for I + V. In addition to evaluating these factors, future research may evaluate the effect of different patient characteristics, including clinical presentation, weight, age, and respiratory comorbidities, on the effectiveness of spirometry parameters in the prediction of the need for I + V.
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Affiliation(s)
- Reema Madike
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia.
| | - Thomas Muecke
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia
| | - Noel Dishnica
- Health and Information, Adelaide SA 5000, Australia; Flinders University, Bedford Park SA 5042, Australia
| | - Linyi Zhu
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia
| | - Joshua Kovoor
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia; Royal Adelaide Hospital, Adelaide SA 5000, Australia
| | - Brandon Stretton
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia; Royal Adelaide Hospital, Adelaide SA 5000, Australia
| | - Aashray Gupta
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia; Gold Coast University Hospital, Southport QLD 4215, Australia
| | - Adil Harroud
- McGill University, Montreal, Quebec H3A 0G4, Canada
| | | | - David Schultz
- Flinders University, Bedford Park SA 5042, Australia
| | - Stephen Bacchi
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia; Flinders University, Bedford Park SA 5042, Australia; Royal Adelaide Hospital, Adelaide SA 5000, Australia
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Reynaud V, Prigent H, Mulliez A, Durand MC, Lofaso F. Phrenic nerve conduction study to diagnose unilateral diaphragmatic paralysis. Muscle Nerve 2020; 63:327-335. [PMID: 33314195 DOI: 10.1002/mus.27144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Unilateral diaphragmatic paralysis (UDP) has major clinical and etiological implications and, therefore, is important to diagnose. Lung function tests and invasive transdiaphragmatic pressure (Pdi) measurements are widely used to this end but, contrary to phrenic nerve conduction study (NCS), they require volitional maneuvers and/or may be poorly tolerated by patients. The purpose of this study was to compare the diagnostic accuracy of Pdi and phrenic NCS for UDP. METHODS We retrospectively reviewed 28 patients with suspected UDP. The diagnosis established during a multidisciplinary meeting was the reference standard. RESULTS Phrenic NCS correlated well with Pdi (r = 0.82, P < .005), and the two tests showed good agreement (κ = 0.82, P < .005). Phrenic NCS and Pdi measurements both had 95% sensitivity, 87.5% specificity, 95% positive predictive, and 87.5% negative predictive values. CONCLUSIONS Both tests were highly sensitive and specific. Phrenic NCS measurement is a simple, reproducible, noninvasive method whose results correlate well with Pdi and provide insight into the UDP mechanism. In the most difficult cases, combining lung function tests, respiratory muscle assessments, and phrenic NCS can help to establish the diagnosis.
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Affiliation(s)
- Vivien Reynaud
- Centre Médical Germaine Revel, Chabanière, France.,Service de Physiologie et Explorations Fonctionnelles, GH Paris Ile de France Ouest - Site Raymond Poincaré - APHP, Garches, France
| | - Hélène Prigent
- Service de Physiologie et Explorations Fonctionnelles, GH Paris Ile de France Ouest - Site Raymond Poincaré - APHP, Garches, France
| | - Aurélien Mulliez
- Direction recherche clinique et Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie-Christine Durand
- Service de Physiologie et Explorations Fonctionnelles, GH Paris Ile de France Ouest - Site Raymond Poincaré - APHP, Garches, France
| | - Frédéric Lofaso
- Service de Physiologie et Explorations Fonctionnelles, GH Paris Ile de France Ouest - Site Raymond Poincaré - APHP, Garches, France
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Luo H, Hong S, Li M, Wang L, Jiang L. Risk factors for mechanical ventilation in children with Guillain-Barré syndrome. Muscle Nerve 2020; 62:214-218. [PMID: 32367533 DOI: 10.1002/mus.26905] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/23/2020] [Accepted: 04/25/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND We assessed clinical predictors of mechanical ventilation in children with Guillain-Barré syndrome (GBS) to help identify patients who require mechanical ventilation. METHODS We retrospectively collected the clinical, laboratory, and electrophysiological data of 103 children with GBS. Patients were categorized into two groups based on the requirement for mechanical ventilation. Variables that were significantly different between the two groups in univariate analysis were analyzed by multivariate logistic regression models. RESULTS Time from symptom onset to admission (P = .002), facial or bulbar weakness (P = .001), and axonal type (P = .005) were associated with mechanical ventilation in univariate analysis. In multivariate analysis, facial or bulbar weakness (odds ratio [OR], 7.936; P = .013) and axonal type (OR, 4.582; P = .022) were independent predictors for mechanical ventilation. CONCLUSIONS Facial or bulbar weakness and axonal type were associated with increased risk for mechanical ventilation in children with GBS.
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Affiliation(s)
- Hanyu Luo
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, P.R. China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics, Chongqing, P.R. China
| | - Siqi Hong
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, P.R. China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics, Chongqing, P.R. China
| | - Mei Li
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, P.R. China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics, Chongqing, P.R. China
| | - Li Wang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, P.R. China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics, Chongqing, P.R. China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, P.R. China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics, Chongqing, P.R. China
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Yang L, Zhao X. Integrated Chinese and Western Medicine for Acute Guillain-barré Syndrome Treatment. Transl Neurosci 2020; 11:38-47. [PMID: 32161685 PMCID: PMC7053400 DOI: 10.1515/tnsci-2020-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/31/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction Guillain-Barré syndrome (GBS) is a worldwide demyelinating polyradiculopathy and polyneuropathy. Currently, there is no specific drug for GBS, and established treatment is generally based on immune-modulating treatment with plasma exchange or intravenous immunoglobulin in combination with supportive care. This study aimed to investigate the efficiency of integrated Chinese and Western medicine for acute GBS treatment. Methods We enrolled 73 subjects, and randomly divided them into two groups: 35 cases in the traditional Chinese medicine (TCM) group, and 28 in the Control group. The Control group was treated with the common Western medicine for one month; and the TCM group was administrated with one month of common treatment combined with TCM medication. Results Compared to the controls, TCM significantly enhanced the treatment efficiency in symptom expression, including the TCM syndrome score, the activity of daily living score, Hughes functional score and sensory dysfunction assessment. The total effective rate of the TCM group was 94.29%, significantly better than controls (78.59%). Moreover, TCM provide better improvement in motor nerve conduction functions (distal motor latency and motor conduction velocity) and sensory nerve conduction functions (sensory conduction velocity and sensory nerve action potential) in median nerve, ulnar nerve, and common fibular nerve. Conclusion When combined with TCM administration, the GBS treatment could acquire better outcomes.
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Affiliation(s)
- Liu Yang
- Shanghai Dunlu Biomedical Technology Co., Ltd. Shanghai, China
| | - Xiumin Zhao
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Green C, Baker T, Subramaniam A. Predictors of respiratory failure in patients with Guillain-Barré syndrome: a systematic review and meta-analysis. Med J Aust 2019; 208:181-188. [PMID: 29490222 DOI: 10.5694/mja17.00552] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/16/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To systematically review the literature regarding the ability of clinical features to predict respiratory failure in patients with Guillain-Barré syndrome (GBS). DATA SOURCES We searched the PubMed and Ovid MEDLINE databases with the search terms "guillain barre syndrome" OR "acute inflammatory demyelinating polyneuropathy" OR "acute motor axonal neuropathy" OR "acute motor sensory axonal neuropathy" AND "respiratory failure" OR "mechanical ventilation". We excluded articles that did not report the results of original research (eg, review articles, letters), were case reports or series (ten or fewer patients), were not available in English, reported research in paediatric populations (16 years of age or younger), or were interventional studies. Article quality was assessed with the Newcastle-Ottawa quality assessment scale. DATA SYNTHESIS Thirty-four relevant studies were identified. Short time from symptom onset to hospital admission (less than 7 days), bulbar (odds ratio [OR], 9.0; 95% CI, 3.94-20.6; P < 0.001) or neck weakness (OR, 6.36; 95% CI, 2.32-17.5; P < 0.001), and severe muscle weakness at hospital admission were associated with increased risk of intubation. Facial weakness (OR, 3.74; 95% CI, 2.05-6.81; P < 0.001) and autonomic instability (OR, 6.40; 95% CI, 2.83-14.5; P < 0.001) were significantly more frequent in patients requiring intubation in our meta-analyses; however, the differences were not statistically significant in individual multivariable analysis studies. Four predictive models have been developed to assess the risk of respiratory failure for patients with GBS, each with good to excellent discriminative power (area under the receiver operating characteristic curve, 0.79-0.96). CONCLUSIONS AND RELEVANCE Early identification of GBS patients at risk of respiratory failure could reduce the rates of adverse outcomes associated with delayed intubation. Algorithms that predict a patient's risk of subsequent respiratory failure at hospital admission appear more reliable than individual clinical variables.
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Simple bedside predictors of mechanical ventilation in patients with Guillain-Barre syndrome. J Crit Care 2013; 29:219-23. [PMID: 24378177 DOI: 10.1016/j.jcrc.2013.10.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 10/29/2013] [Accepted: 10/30/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of the study is to develop and validate a predictor score for assessing the requirement of mechanical ventilation (MV) in patients with Guillain-Barre syndrome (GBS). STUDY DESIGN The study was conducted in patients admitted with GBS in neurointensive care unit in a tertiary care hospital. The demographic, clinical factors, electrophysiological, and spirometric data of all consecutive patients were prospectively collected. The study was undertaken in 2 stages. In the first stage, data were collected for development of a predictor score. In the second stage, the score developed was validated on a separate set of patient data. RESULTS The data collected were compared between the 2 groups (ventilated vs nonventilated). On univariate analysis, time taken to reach maximum deficit, neck weakness, bulbar weakness, facial weakness, single breath count (SBC), forced vital capacity, and phrenic nerve latency predicted the need for MV. On multivariate analysis, only neck weakness, bulbar weakness, SBC, and forced vital capacity were independent predictors of MV. There was a good correlation between SBC and the spirometric tests and phrenic nerve distal motor latency, as reflected in receiver operating characteristics curve. The predictor score developed using the regression coefficient of independent predictors showed that the best cutoff score for prediction of ventilation was 60 (sensitivity, 0.95; 1--specificity, 0.065). Internal cross validation of the neck weakness, SBC, and bulbar palsy (NSB) score showed good correlation (Pearson R = 0.76; P = .00). There was no statistically significant difference between predicted and observed outcomes (sensitivity, 95%; specificity, 93%). CONCLUSION Several independent risk factors were found to predict the requirement for MV in patients with GBS at admission. However, after scoring and analyzing them, it was found that combining a few of them was more useful to predict the need for MV. A model using NSB score, developed using clinical variables, accurately predicted the requirement of MV. In addition, among the NSB score parameters, simple bedside SBC could adequately assess the adequacy of vital capacity.
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Boudarham J, Pradon D, Prigent H, Falaize L, Durand MC, Meric H, Petitjean M, Lofaso F. Optoelectronic Plethysmography as an Alternative Method for the Diagnosis of Unilateral Diaphragmatic Weakness. Chest 2013; 144:887-895. [DOI: 10.1378/chest.12-2317] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Nason LK, Walker CM, McNeeley MF, Burivong W, Fligner CL, Godwin JD. Imaging of the Diaphragm: Anatomy and Function. Radiographics 2012; 32:E51-70. [DOI: 10.1148/rg.322115127] [Citation(s) in RCA: 180] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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12
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Sharshar T, Polito A, Porcher R, Merhbene T, Blanc M, Antona M, Durand MC, Friedman D, Orlikowski D, Annane D, Marcadet MH. Relevance of anxiety in clinical practice of Guillain-Barre syndrome: a cohort study. BMJ Open 2012; 2:bmjopen-2012-000893. [PMID: 22923622 PMCID: PMC3432836 DOI: 10.1136/bmjopen-2012-000893] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Illness is often associated with anxiety, but few data exist about the prognostic significance of this phenomenon. To address this issue, we assessed whether patient anxiety is associated with subsequent need for intubation in Guillain-Barré syndrome (GBS). DESIGN Incident case-cohort study. SETTING Acute secondary care in a teaching hospital (France) from 2006 to 2010. PARTICIPANTS 110 adult GBS patients. Either language barrier or cognitive decline that precluded understanding was considered as exclusion criteria. PRIMARY OUTCOME Acute respiratory failure. INTERVENTIONS At admission, anxiety and clinical factors (including known predictors of respiratory failure: delay between GBS onset and admission, inability to lift head, vital capacity (VC)) were assessed and related to subsequent need for mechanical ventilation (MV). Anxiety was assessed using a Visual Analogical Scale (VAS), the State Anxiety Inventory form Y1 (STAI-Y1) score and a novel-specific questionnaire, evaluating fears potentially triggered by GBS. Patients were asked to choose which they found most stressful from weakness, pain, breathlessness and uncertainty. RESULTS 23 (22%) were subsequently ventilated. Mean STAI-Y1 was 47.2 (range 22-77) and anxiety VAS 5.2 (range 0-10). STAI was above 60/80 in 22 (21%) patients and anxiety VAS above 7/10 in 28 (27%) patients. Fear of remaining paralysed, uncertainty as to how the disease would progress and fear of intubation were the most stressful. Factors significantly associated with anxiety were weakness and bulbar dysfunction. STAI-Y1 was higher and uncertainty more frequent in subsequently ventilated patients, who had shorter onset-admission delay and greater weakness but not a lower VC. Uncertainty was independently associated with subsequent MV. CONCLUSIONS Early management of patients with GBS should evaluate anxiety and assess its causes both to adjust psychological support and to anticipate subsequent deterioration.
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Affiliation(s)
- Tarek Sharshar
- Medical Intensive Care Unit, Raymond Poincaré Teaching Hospital, Garches, France
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Abstract
Common peripheral neuropathies do not usually cause diaphragmatic weakness and subsequent respiratory compromise. However, respiratory involvement is relatively common in Guillain-Barré syndrome (GBS). Experience in GBS has led to a standardized approach to manage respiratory problems in peripheral neuropathies. Diaphragmatic weakness is not common in chronic inflammatory demyelinating polyneuropathy and extremely rare in multifocal motor neuropathy. The linkage has been described between certain subtypes of Charcot-Marie-Tooth (CMT) disease such as CMT2C and CMT4B1 and diaphragmatic weakness. A correlation usually has not been found between electrophysiologic findings and clinical respiratory signs or spirometric abnormalities in peripheral neuropathies except in amplitudes of evoked phrenic nerve responses. Careful and frequent assessment of respiratory function by a qualified team of healthcare professionals and physicians is essential. Criteria established for mechanical ventilation in GBS cases may be applied to other peripheral neuropathies with respiratory compromise as necessary.
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Affiliation(s)
- Ahmet Z Burakgazi
- Department of Neurology, George Washington University, Washington, DC, USA
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Morélot-Panzini C, Fournier E, Donzel-Raynaud C, Dubourg O, Willer JC, Similowski T. Conduction velocity of the human phrenic nerve in the neck. J Electromyogr Kinesiol 2009; 19:122-30. [PMID: 17888682 DOI: 10.1016/j.jelekin.2007.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 06/27/2007] [Accepted: 06/27/2007] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To measure phrenic nerve conduction velocity in the neck in humans. SCOPE We studied 15 healthy subjects (9 men, 32.4+/-6.7). We performed bipolar electrical phrenic stimulation in the neck, from a distal and a proximal stimulation site, and recorded diaphragm electromyographic responses on the surface of the chest. The ratio of the between-site distance to the latency difference provided phrenic velocities. Ulnar motor velocity was assessed similarly. In addition, five homogeneous patients with Charcot-Marie-Tooth disease type 1A (CMT1A) were studied for validation purposes. We obtained diaphragmatic responses from the two stimulation sites in all cases. The distal latencies (anterior axillary line recording) were 6.51+/-0.63ms (right) and 6.13+/-0.64ms (left). The minimal between site distance was 39mm. Phrenic motor velocity was 55.2+/-6.3ms(-1) (right) and 56.3+/-7.2ms(-1) (left). In CMT1A, phrenic velocities were 17.1+/-8.1ms(-1) (from 7 to 32ms(-1)) and were similar to ulnar and median velocities. CONCLUSIONS Phrenic nerve velocities can be estimated in humans and compare with upper limb motor conduction velocities. This should refine the investigation of phrenic function in peripheral neuropathies.
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Affiliation(s)
- Capucine Morélot-Panzini
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Laboratoire de Physiopathologie Respiratoire du Service de Pneumologie et Réanimation, Paris, France
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Sivadon-Tardy V, Orlikowski D, Porcher R, Sharshar T, Durand MC, Enouf V, Rozenberg F, Caudie C, Annane D, van der Werf S, Lebon P, Raphaël JC, Gaillard JL, Gault E. Guillain-Barré syndrome and influenza virus infection. Clin Infect Dis 2009; 48:48-56. [PMID: 19025491 DOI: 10.1086/594124] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In Western countries, the cause of 60% of all Guillain-Barré syndrome (GBS) cases remains unidentified. The number of cases of unidentified cause peaks in winter, and these cases are commonly preceded by respiratory tract infection or influenza-like illness. We investigated the triggering role of influenza virus infection. METHODS Of 405 patients with GBS who were admitted to a French reference center during 1996-2004, 234 had cases caused by an unidentified agent. We used time-series methods to study the correlation between the monthly incidence of such cases and influenza-like illnesses reported by the Sentinelles surveillance network. We analyzed anti-influenza antibodies using complement fixation testing and hemagglutination-inhibition assays. We studied etiological subgroups using Wilcoxon and Fisher's exact tests. RESULTS We found a positive association between the monthly incidence of GBS caused by an unidentified agent and reported influenza-like illnesses. Of 73 patients whose cases occurred during periods in which there was a possible link to influenza, 10 (13.7%) had serological evidence of recent influenza A, and 4 (5.5%) had serological evidence of influenza B. Eight of 10 influenza A-related cases occurred during "major" influenza seasons, and antibodies specific to the current epidemic strain were found in 9 cases. Most patients with influenza A-related cases were aged < 65 years, and none had antiganglioside antibodies. Influenza-related cases differed both from Campylobacter jejuni-related cases, with regard to the lack of need for mechanical ventilation (P = .014), and from the cases caused by an unidentified agent, with regard to the presence of preceding influenza-like illness or respiratory tract infection (P = .015) and longer time from the infectious event to GBS onset (P = .04). CONCLUSIONS Influenza viruses are infrequent triggering agents of GBS but may play a significant role during major influenza outbreaks. Influenza-related GBS displays specific features and is not associated with antiganglioside antibody response, which suggests the presence of underlying immune mechanisms.
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Affiliation(s)
- Valérie Sivadon-Tardy
- Laboratoire de Microbiologie, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
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Prigent H, Orlikowski D, Fermanian C, Lejaille M, Falaize L, Louis A, Fauroux B, Lofaso F. Sniff and Muller manoeuvres to measure diaphragmatic muscle strength. Respir Med 2008; 102:1737-43. [DOI: 10.1016/j.rmed.2008.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 06/30/2008] [Accepted: 07/03/2008] [Indexed: 10/21/2022]
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Ito H, Ito H, Fujita K, Kinoshita Y, Takanashi Y, Kusaka H. Phrenic nerve conduction in the early stage of Guillain-Barre syndrome might predict the respiratory failure. Acta Neurol Scand 2007; 116:255-8. [PMID: 17824905 DOI: 10.1111/j.1600-0404.2007.00874.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate whether phrenic nerve conduction in the early phase of Guillain- Barre syndrome (GBS) predicts the need for respiratory assistance during the subsequent clinical course. MATERIAL AND METHODS We performed electrophysiological examinations of conventional peripheral nerve conduction and phrenic nerve conduction for GBS patients within 14 days from the onset. We excluded patients who had already been treated with immuno-related therapy and respiratory assistance. RESULTS Fifteen patients were enrolled. Three patients with the sum of phrenic nerve latency longer than 30 ms and the sum of bilateral diaphragmatic compound muscle action potential amplitude smaller than 0.3 mV required respiratory assistance after the conduction test. CONCLUSION Our findings showed that not only delayed distal latency but also decreased amplitude may predict the need for respiratory assistance during the subsequent disease course.
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Affiliation(s)
- H Ito
- Department of Neurology, Tokyo-west Tokushukai Hospital, Akishima, Tokyo, Japan.
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Durand MC, Porcher R, Orlikowski D, Aboab J, Devaux C, Clair B, Annane D, Gaillard JL, Lofaso F, Raphael JC, Sharshar T. Clinical and electrophysiological predictors of respiratory failure in Guillain-Barré syndrome: a prospective study. Lancet Neurol 2007; 5:1021-8. [PMID: 17110282 DOI: 10.1016/s1474-4422(06)70603-2] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Respiratory failure is the most serious short-term complication of Guillain-Barré syndrome and can require invasive mechanical ventilation in 20-30% of patients. We sought to identify clinical and electrophysiological predictors of respiratory failure in the disease. METHODS We prospectively assessed electrophysiological data and clinical factors, including identified predictors of delay between disease onset and admission, inability to lift head, and vital capacity, in patients admitted with Guillain-Barré syndrome. We related these factors to subsequent need for ventilatory support. Neurophysiological findings were classified as demyelinating, axonal, equivocal, unexcitable, or normal. Predictive values of clinical and electrophysiological data were tested using classification trees to build up a predictive model. This model was initially built up in a two-third (fitting set) then validated in a one-third (validation set) of the total sample. The fitting and validation sets were randomly selected. We also assessed the predictive value of this model for disability at 6 months. FINDINGS From 1998, to 2006, 154 patients with Guillain-Barré syndrome were included in the study and 34 (22%) were subsequently ventilated. Demyelinating Guillain-Barré syndrome was more common in patients who went on to be ventilated than in those who were not (85%vs 51%, p=0.0003). Vital capacity and the proximal/distal compound muscular amplitude potential (p/dCMAP) ratio of the common peroneal nerve were retained in the tree model, with a probability of needing ventilation of less than 2.5% in patients with a ratio of greater than 55.6% and a vital capacity more than 81% of predicted. A p/dCMAP ratio of the peroneal nerve less than 55.6% and age older than 40 years were retained as independent predictors of disability at 6 months. INTERPRETATION Neurophysiological testing is helpful for assessing risk of respiratory failure, which is highest in patients with evidence of demyelination and very low in those without both 55.6% conduction block of the common peroneal nerve and a 20% reduction in vital capacity.
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Phillips LH. What's in the Literature? J Clin Neuromuscul Dis 2006; 7:115-122. [PMID: 19078796 DOI: 10.1097/01.cnd.0000210111.12138.5a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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