Coexisting infectious diseases on admission as a risk factor for mechanical ventilation in patients with Guillain–Barré syndrome

BACKGROUND Patients with Guillain-Barré syndrome are commonly exposed to prolonged mechanical ventilation. Specific data on ventilatory management of these patients have been limited. OBJECTIVE To describe the practice of mechanical ventilation in patients with Guillain-Barré syndrome and evaluate risk factors for morbidity and mortality. METHODS We describe a historical cohort of mechanically ventilated patients with Guillain-Barré syndrome in a tertiary-care center. We extracted database information on demographics, severity of illness, pulmonary function, and ventilatory management for the period 1976 to 1996. Primary outcomes were development of pulmonary complications, duration of ventilatory support, and mortality. RESULTS Fifty-four patients met the inclusion criteria. After 1990, lower tidal volume (p = 0.031) and higher positive end-expiratory pressure (p = 0.003) were used than during the 1976 to 1990. Outcomes did not change significantly during the studied period. Forty-six patients (85%) survived to hospital discharge, and 39 (72%) were alive at 1-year follow-up. Ventilator-associated pneumonia was the most frequent complication (56%) and was associated with prolonged mechanical ventilation (p < 0.01). Atelectasis developed in 49%, and acute lung injury in 13%. All but 6 patients (89%) received tracheostomy. In 14 patients (30%) tracheostomy was placed > or = 14 days after intubation. When adjusted for atelectasis and severity of illness in a stepwise logistic regression analysis, delayed tracheostomy was associated with the development of ventilator-associated pneumonia (odds ratio 8.2, p = 0.029). CONCLUSIONS Changes in ventilator practice did not affect outcomes of mechanically ventilated patients with Guillain-Barré syndrome. The majority of patients received tracheostomy, which should be considered early in the course of respiratory failure.