Combating Respiratory Failure in Guillain–Barré Syndrome within a Resource-Limited Rural ICU: A 7-Month Weaning Journey

Felicia Handoko, Emmanuel Nera Kurnia Kasmantinno, Pande Nyoman Kurniasari, I Gusti Ayu Ketut Swarningasih, Made Bayu Agastia Rakateja, Astrid Priscilla Amanda

Abstract

Background : Respiratory failure in Guillain–Barré syndrome (GBS) is the most dangerous complication. Approximately 22% of patients with GBS require a mechanical ventilation (MV) within the first week of hospital admission. Management of the patient with prolonged MV during ICU stay has been challenging, especially in resource-limited rural areas. The important consideration is the patient's ability to regain spontaneous breathing to evaluate the readiness to wean and the optimal time for deciding to decannulation.

Case Illustration : We reported a case about the management of respiratory failure due to GBS in the ICU involving a 37-year-old woman presented to the emergency room due to rapidly progressive weakness. The patient was treated with a 5-day course of intravenous immunoglobulin (IVIG). After 25days with a MV, the patient underwent bedside PDT as a choice for critically ill patients who require prolonged MV in the ICU. The patient's motor development during the treatment period in the ICU showed a slow progression. There was no further significant progress in the patient's motor development for up to six months. Furthermore, on day 183 of the treatment, muscle recovery began to become obvious. We found a successful liberation of dependency after 207 days on MV and successful decannulation of the tracheostomy tube on day 215 in a hospital with limited facilities in rural areas. The patient was transferred from the ICU to the ward on day 217 and discharged on day 219. A one-month follow-up showed there were no respiratory complaints.

Conclusion: Long-term care for a GBS patient with prolonged MV in the ICU requires a multidisciplinary team approach, including optimization of treatment, nutrition, rehabilitation as well as psychological support. Comprehensive ICU care is the key to success in our case.

Keywords

Guillain–Barré syndrome, Mechanical ventilation, Percutaneous dilatational tracheostomy, Respiratory failure.

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References

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DOI: https://doi.org/10.20961/soja.v5i2.91577

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