Guillain-Barré Syndrome

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Chapter 63 Guillain-Barré Syndrome

8 When should patients with GBS have an endotracheal tube placed?

Respiratory failure is often caused by a combination of respiratory muscle insufficiency and difficulty clearing secretions or inability to cough and protect the airway. This can be complicated by aspiration and respiratory tract infections. Bedside pulmonary function testing is helpful but may be difficult in patients with significant facial weakness because of the decreased ability to form a good seal. Clinical symptoms of neuromuscular respiratory failure include rapid and shallow breathing, restlessness, sweating, and increased accessory muscle use with the presence of paradoxical abdominal movements during inspiration.

Indications for intubation are not always clear, but the decision is supported by the presence of severe bulbar weakness with difficulty to handle secretions and protect airway, and rapidly evolving motor weakness. A vital capacity of less than 15 to 20 mL/kg and a maximum negative inspiratory pressure of less than −20 mm Hg can also indicate need for intubation. Because these patients often have facial weakness that prevents a tight seal around the lips, surrogate measures of vital capacity such as having the patient count out loud as high as he or she can in one breath may be useful (approximately 100 mL for each number counted slowly). Hypoxia by pulse oximetry or arterial blood gas measurements are only very late signs of respiratory muscle failure and if normal should not provide reassurance as to the stability of the condition of the patient with GBS. Hypercapnia and respiratory acidosis are also late signs of respiratory failure and should prompt rapid institution of ventilatory support.

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