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Tracheostomy in children with Guillain Barré syndrome
1Department of Thoracic Medicine, Royal Children's Hospital, Melbourne, Australia.
Insights
Tracheostomy is a safe procedure for children with Guillain Barré syndrome (GBS) requiring prolonged ventilation. Most patients recovered fully, with no significant long-term complications reported.
Area of Science:
- Pediatric Neurology
- Respiratory Medicine
- Critical Care
Background:
- Guillain Barré syndrome (GBS) can necessitate prolonged mechanical ventilation in pediatric patients.
- Tracheostomy is often considered for long-term airway management in such cases.
- Assessing the safety and outcomes of tracheostomy in this population is crucial.
Purpose of the Study:
- To evaluate the safety and efficacy of tracheostomy in infants and children with GBS requiring extended mechanical ventilation.
- To assess pulmonary function and respiratory muscle strength post-tracheostomy.
- To identify any tracheostomy-related complications and long-term outcomes.
Main Methods:
- Retrospective review of 15 pediatric GBS patients who underwent tracheostomy.
- Assessment of pulmonary function and respiratory muscle strength in 14 patients post-decannulation.
- Analysis of ventilation duration, tracheostomy duration, and complication rates.
Main Results:
- Median assisted ventilation duration was 21 days; median tracheostomy duration was 39 days.
- All patients were successfully decannulated without complications, except for two cases of croup.
- Post-decannulation pulmonary function, respiratory muscle strength, and airway assessments were normal.
Conclusions:
- Tracheostomy is a safe and well-tolerated procedure for pediatric GBS patients needing long-term ventilation.
- The procedure is associated with good functional recovery and minimal long-term adverse effects.
- No deaths occurred, and most patients returned to normal activities, indicating successful management.
Abstract:
During the 10-yr period beginning January 1979, 59 infants and children with Guillain Barré syndrome (GBS) were admitted to our hospital. Tracheostomies were performed in 15 patients and their records were reviewed. Fourteen patients were recalled for assessment of pulmonary function and respiratory muscle strength (RMS). The median duration of assisted ventilation (including endotracheal [ET] intubation) was 21 days and the median duration of tracheostomy was 39 days. Only two patients were discharged with the tracheostomy in situ. All patients were successfully decannulated at the first attempt. No tracheostomy-related complications or symptoms were reported apart from croup in two patients. On review, lung volumes and maximal inspiratory and expiratory flows were normal. There was no evidence of tracheal stenosis or significant tracheomalacia. RMS tests were normal. In this hospital, tracheostomy is a safe, well-tolerated procedure in the management of infants and children with GBS who need long-term ventilation. There were no deaths and all patients returned to their normal school or were gainfully employed after their illness, although 12 patients had mild persistent weakness of at least foot dorsiflexion.