Response and Clinical Outcome of Critically Ill Children with Guillain Barre Syndrome admitted to PICU of Children’s Hospital Lahore

Abstract

Objective: To analyze patients with Guillain Barre Syndrome (GBS) requiring intensive care unit (ICU) admission, their course, response to treatment and outcome.

Methods: A retrospective study conducted at ICU of The Children’s Hospital Lahore in 194 children with diagnosis of GBS from June 2018 to May 2020. Demographic profile, clinical features, treatment, duration of mechanical ventilation, length of ICU stay and outcome was noted.  

Results:

Mean age of children was 5.95 ± 3.1 years with male predominance 136 (70 %). Major proportion were in range of 1-5 years 93(47.9%). Mean duration of ICU stay was 21.3±34.4 days. Out of 194 patients 125(64%) received IVIGs while 112 (57.7%) required mechanical ventilation because of rapidly progressive weakness within 24 hours of admission and those who remained on mechanical ventilation for longer period showed AMSAN (Acute motor sensory axonal neuropathy) type of GBS ( p value <0.001). Tracheostomy was performed in 22.7% of patients who were difficult to wean off from ventilator. Among nerve conduction studies AIDP (Acute inflammatory demyelinating polyneuropathy) was predominant 48% associated with p value <0.001 in those who showed complete recovery, followed by AMSAN 24%, AMAN ( Acute motor axonal neuropathy) 13.4% and miscellaneous 13.9 %. Regarding outcome complete recovery was seen in 28%, minimal residual disability in 70% and 1.5% remained ventilator dependent.

Conclusion:

Patients of severe GBS often require prolong respiratory support and ICU care. The indicators of poor outcome are rapidly progressive course, severe weakness and axonal neuropathy leading to longer duration on mechanical ventilation.

KEYWORDS: 

Guillain Barre Syndrome, Outcome, intensive care unit (ICU)