Long term intubation and successful weaning in two children with Guillain-Barre syndrome

Area of Science:

• Pediatric Neurology
• Critical Care Medicine
• Respiratory Therapy

Background:

• Guillain-Barre syndrome can necessitate prolonged mechanical ventilation in children.
• Established criteria for managing prolonged ventilation, specifically endotracheal intubation versus tracheostomy, are lacking in pediatric Guillain-Barre syndrome.
• The use of a T-piece for weaning from mechanical ventilation requires further investigation in this population.

Observation:

• Two pediatric patients with Guillain-Barre syndrome required extended endotracheal intubation (56 days) and mechanical ventilation (30 days).
• Both children were successfully weaned from mechanical ventilation utilizing a T-piece.
• No tracheostomy was performed in either case.

Findings:

• Prolonged endotracheal intubation with subsequent T-piece weaning is a feasible strategy for pediatric Guillain-Barre syndrome.
• This management approach facilitated complete recovery in both reported cases.
• The use of a portex tube for prolonged ventilation demonstrated comparable or superior outcomes to tracheostomy, avoiding associated risks.

Implications:

• This case series suggests that prolonged endotracheal intubation and T-piece weaning can be a safe and effective alternative to tracheostomy in pediatric Guillain-Barre syndrome.
• Clinicians may consider this approach for children requiring extended mechanical ventilatory support, potentially reducing complications associated with tracheostomy.
• Further research is warranted to establish definitive guidelines for managing prolonged ventilation in pediatric Guillain-Barre syndrome.