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Factors Predicting Prolonged Mechanical Ventilation in Guillain–Barré Syndrome
Published online by Cambridge University Press: 15 February 2023
Abstract:
Background:
Up to 30% of patients with Guillain–Barré syndrome require mechanical ventilation and 5% die due to acute complications of mechanical ventilation. There is a considerable group of patients that will need prolonged mechanical ventilation (considered as >14 days) and should be considered for early tracheostomy. The objective of this study is to identify risk factors for prolonged mechanical ventilation.
Methods:
We prospectively analyzed patients with Guillain–Barré diagnosis with versus without prolonged mechanical ventilation. We considered clinical and electrophysiological characteristics and analyzed factors associated with prolonged mechanical ventilation.
Results:
Three hundred and three patients were included; 29% required mechanical ventilation. When comparing the groups, patients with prolonged invasive mechanical ventilation (IMV) have a lower score on the Medical Research Council score (19.5 ± 16.2 vs 27.4 ± 17.5, p = 0.03) and a higher frequency of dysautonomia (42.3% vs 19.4%, p = 0.037), as well as lower amplitudes of the distal compound muscle action potential (CMAP) of the median nerve [0.37 (RIQ 0.07–2.25) vs. 3.9 (RIQ1.2–6.4), p = <0.001] and ulnar nerve [0.37 (RIQ0.0–3.72) vs 1.5 (RIQ0.3–6.6), p = <0.001], and higher frequency of severe axonal damage in these nerves (distal CMAP ≤ 1.0 mV). Through binary logistic regression, severe axonal degeneration of the median nerve is an independent risk factor for prolonged IMV OR 4.9 (95%CI 1.1–21.5) p = 0.03, AUC of 0.774, (95%CI 0.66–0.88), p = < 0.001.
Conclusions:
Severe median nerve damage is an independent risk factor for prolonged mechanical ventilation.
Résumé :
Les facteurs prédictifs du recours à la ventilation mécanique prolongée dans le cas du syndrome de Guillain-Barré.
Jusqu’à 30 % des patients atteints du syndrome de Guillain-Barré (SGB) ont besoin de ventilation mécanique tandis que 5 % d’entre eux finissent par décéder en raison de complications aiguës liées à ce dispositif. Il existe aussi un groupe considérable de patients qui auront besoin de ventilation mécanique prolongée (VMP) (> 14 jours) et qui devraient être considérés pour une trachéotomie précoce. L’objectif de cette étude est donc d’identifier les facteurs de risque du recours à la VMP.
Nous avons analysé prospectivement des patients ayant reçu un diagnostic de SGB avec ou sans recours à la VMP. Nous avons pris en compte leurs caractéristiques cliniques et électro-physiologiques et ainsi analysé les facteurs associés à ce recours.
Au total, ce sont 303 patients qui ont été inclus dans notre étude ; de ce nombre, 29 % d’entre eux ont eu besoin de la ventilation mécanique. En comparant entre eux nos groupes de patients, nous avons trouvé que ceux ayant recouru à la ventilation obligatoire intermittente (VOI) prolongée donnaient à voir des scores moins élevés à l’échelle du Modified Medical Research Council (19,5 ± 16,2 contre 27,4 ± 17,5 ; p = 0,03), une fréquence plus élevée de dysautonomie (42,3 % contre 19,4 % ; p = 0,037), des amplitudes plus basses du potentiel d’action musculaire composé (PAMC ou compound muscle action potential) de la partie distale du nerf médian [0,37 (EI 0,07 – 2,25) contre 3,9 (EI 1,2 - 6,4), p = < 0,001] et du nerf ulnaire [0,37 (EI 0,0 – 3,72) contre 1,5 (EI 0,3 – 6,6), p = < 0,001] et finalement une fréquence plus élevée de dommages axonaux sévères dans ces nerfs (PAMC de la partie distale ≤ 1,0 mV). Grâce à la régression logistique binaire, on a pu noter que la dégénérescence axonale sévère du nerf médian constitue un facteur de risque indépendant du recours à la VOI prolongée [RC : 4,9 (IC 95 % 1,1-21,5), p = 0,03 ; surface sous la courbe : 0,774 (IC 95 % 0,66 - 0,88), p = < 0,001].
En somme, une atteinte grave du nerf médian représente un facteur de risque indépendant du recours à la VMP.
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- © The Author(s), 2023. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation
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