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From the Departments of Physical Medicine and Rehabilitation (Dr. Fletcher) and Neurology (Drs. Lawn and Wijdicks) and Section of Biostatistics (T.D. Wolter), Mayo Clinic and Foundation, Rochester, MN.
Address correspondence and reprint requests to Dr. Wijdicks, Department of Neurology, W8A, Mayo Clinic, 200 First Street SW, Rochester, MN 55902; e-mail: wijde{at}mayo.edu
OBJECTIVE: To analyze long-term recovery and predictors of outcome in patients with Guillain–Barré syndrome (GBS) requiring mechanical ventilation.
METHODS: The clinical and electrophysiologic data of 114 patients with GBS admitted to the intensive care unit between 1976 and 1996 (60 mechanically ventilated, 54 nonventilated) were reviewed. Functional disability and predictors of outcome were determined at 1 year and at maximal recovery using the Hughes scale. Good outcome was defined as ability to ambulate without assistance; poor outcome was defined as inability to ambulate independently.
RESULTS: Mechanical ventilation was required in 81% of patients with a poor outcome. Mortality was 20% in patients ventilated for GBS. However, ventilated patients who survived did well, with 79% eventually regaining independent ambulation. Nineteen percent of patients improved at least one functional grade beyond 1 year. Univariate predictors of poor maximal recovery in ventilated GBS patients were increased age (p < 0.001)), upper limb paralysis (p = 0.004), duration of ventilation (p = 0.006), and delay of more than 2 days to transfer to a tertiary center (p < 0.001). However, only age (OR 1.99, p = 0.004) and delayed transfer (OR 19.8, p = 0.002) were independently predictive of poor outcome on multivariate analysis.
CONCLUSION: Mechanically ventilated patients constitute the majority of GBS patients with a poor outcome, and mortality remains substantial in this subgroup (20%). Although recovery from severe GBS may be prolonged, most survivors regain independent ambulation.
Key words: Guillain–Barré syndrome—Outcome—Mechanical ventilation.
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