GUILLAIN BARRE SYNDROME (GBS)-MANAGEMENT
SUMMARY
1. Measurement of vital capacity (VC), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) are used for the bedside estimation of diaphragmatic strength & to predict respiratory failure.
2. Use the 20-30-40 rule to determine need for ventilator support. VC < 20 mL/kg, MIP less negative than -30 cmH2O, and MEP < 40 cmH2O.
3. Plasmapheresis and IV immunoglobulin therapy (IVIG) are equally effective. Use if patients present within 1 week, with some benefit if administered within 4 weeks of onset. Steroids are not useful!
4. IVIg dose: 2g/kg over 2-5 days; plasmapheresis: 4-5 treatments over 7-10 days.
5. Autonomic surveillance (cardiac & BP monitoring), DVT prophylaxis, analgesia for neuropathic pain, pressure ulcer prevention.
6. Prognosis: 80% recover completely; 10% have a prolonged course with/without residual weakness; 5% perish.
Reference(s)
Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].
