Age-Related Differences in Respiratory Outcomes Among Critically Ill Children with Guillain-Barré Syndrome

To evaluate age-related differences in respiratory outcomes among critically ill children with Guillain-Barré syndrome (GBS), focusing on mechanical ventilation (MV) requirements and tracheostomy placement.

This retrospective cohort study analyzed data collected prospectively within the Virtual Pediatric Systems registry (2009-2020) for US children <21 years diagnosed with GBS and admitted to an intensive care unit (ICU). The primary outcome evaluated was use of invasive mechanical ventilation (IMV). Secondary outcomes included MV duration and use of tracheostomy.

Among 497 children, 185 (37.2%) required IMV, 14 (2.8%) required only noninvasive ventilation, and 45 (9.1%) received a tracheostomy. Most patients (82.7%) requiring either invasive or non-IMV received it within 24 hours of ICU admission. Compared with children ≥12 years, younger children had higher odds of requiring IMV (age <2 years: adjusted odds ratio (aOR) 3.12 [95% CI 1.37, 7.10]; age ≥2-6 years: aOR 1.87 [95% CI 1.07, 3.28]), but experienced shorter duration of ventilation (age ≥2-6 years: adjusted hazard ratio 2.37 [95% CI 1.55, 3.63]; age ≥6-12 years: adjusted hazard ratio 1.74 [95% CI 1.21, 2.50]) and had lower tracheostomy rates (age ≥2-6 years: aOR 0.21 [95% CI 0.07, 0.61]; age ≥6-12 years: aOR 0.35 [95% CI 0.12, 0.99]) when they received IMV.

Most children with GBS admitted to an ICU in the US do not require MV; among those who do, support is typically initiated within 24 hours of ICU admission. There are age-related variations in respiratory outcomes that may help inform clinical management.