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Clinical Features Associated With Need for Mechanical Ventilation in Children With Guillain-Barré Syndrome:
Manjinder Singh Randhawa1, Rajalakshmi Iyer2, Arun Bansal1
1Division of Pediatric Critical Care, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Severe neuromuscular weakness in children with Guillain-Barré syndrome (GBS) at admission predicts the need for mechanical ventilation (MV). Greater weakness correlates with prolonged MV duration, aiding critical care prioritization.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Neuromuscular Disorders
Background:
- Guillain-Barré syndrome (GBS) is a rare autoimmune disorder affecting children.
- Mechanical ventilation (MV) is a critical intervention for GBS patients with respiratory compromise.
- Predicting the need for MV in pediatric GBS is essential for timely resource allocation.
Purpose of the Study:
- To identify clinical features associated with the requirement for mechanical ventilation (MV) in pediatric Guillain-Barré syndrome (GBS).
- To determine predictors for prolonged MV use in children with GBS.
Main Methods:
- Retrospective cohort study of pediatric GBS patients admitted to a single-center Pediatric Intensive Care Unit (PICU) from 2010-2019.
- Analysis of clinical data, including neurological examination findings, Hughes disability score, and nerve conduction studies.
- Statistical analysis to identify associations between admission characteristics and the need for MV, including prolonged MV (> 21 days).
Main Results:
- Of 189 pediatric GBS patients, 52% required invasive MV, with a median duration of 25 days.
- Admission findings significantly associated with MV need included upper limb power ≤3, lower limb power ≤2, and cranial nerve palsy.
- More severe weakness (upper limb power ≤2, lower limb power ≤1) predicted prolonged MV (> 21 days).
Conclusions:
- Severe neuromuscular weakness at admission is a key predictor for mechanical ventilation in pediatric GBS.
- The degree of weakness at admission correlates with the duration of MV required.
- Early identification of these clinical signs can guide critical care management and facilitate timely PICU transfer for pediatric GBS patients.
Objectives:
To analyze the clinical features associated with the need for mechanical ventilation (MV) in children with Guillain-Barré syndrome (GBS).
Design:
Retrospective cohort study, 2010-2019.
Setting:
PICU.
Patients:
All children, 1 month to 12 years old, diagnosed with GBS in our single-center PICU.
Intervention:
Retrospective chart and data review.
Measurements And Main Results:
Out of 189 children identified with a diagnosis of GBS, 130 were boys (69%). The median (interquartile range [IQR]) age was 6 years (3-9 yr). At admission, the Hughes disability score was 5 (4-5), and cranial nerve palsies were present in 81 children (42%). Autonomic instability subsequently occurred in a total of 97 children (51%). In the 159 children with nerve conduction studies, the axonal variant of GBS (102/159; 64%) predominated, followed by the demyelinating variant (38/189; 24%). All children received IV immunoglobulins as first-line therapy at the time of admission. The median (IQR) length of PICU stay was 12 days (3-30.5 d). Ninety-nine children (52%) underwent invasive MV, and median duration of MV was 25 days (19-37 d). At admission, upper limb power less than or equal to 3 (p = 0.037; odds ratio (OR), 3.5 [1.1-11.5]), lower limb power less than or equal to 2 (p = 0.008; OR, 3.5 [1.4-8.9]), and cranial nerve palsy (p = 0.001; OR, 3.2 [1.6-6.1]) were associated with subsequent need for MV. Prolonged (> 21 d) MV was associated with more severe examination findings at admission: upper limb power less than or equal to 2 (p < 0.0001; OR, 4.2 [2.5-6.9]) and lower limb power less than or equal to 1 (p < 0.0001; OR, 4.5 [2.6-7.9]).
Conclusions:
In children with GBS, referred to our center in North India, severe neuromuscular weakness at admission was associated with the need for MV. Furthermore, greater severity of this examination was associated with need for prolonged (> 21 d) MV. Identification of these signs may help in prioritizing critical care needs and early PICU transfer.
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