Predictive Factors of Respiratory Failure in Children with Guillain-Barre Syndrome

Abstract

Introduction Guillain-Barre Syndrome (GBS) is the most common cause of acute flaccid paralysis. Respiratory failure is the most serious short-term complication of GBS and invasive mechanical ventilation is required in 30% of patients. Moreover, 60% of those who are intubated develop major complications including pnemonia, sepsis, GI bleeding and pulmonary embolism. Thus respiratory failure prediction is crucial. The aim of this study was to determine clinical predictors of respiratory failure to avoid respiratory distress and aspiration. Materials and Methods In a cross sectional and analytical study 140 patients with clinically diagnosis of Guillain-Barre syndrome were enrolled in study, of October 2008 to October 2014. Demographic data, nerologic examination, cranial nerve and autonomic nervous system involvement, and respiratory failure were recorded prospectively. Results 15 out of 140 patients (10.7%) developed respiratory failure and underwent mechanical ventilation. The male/female ratio in patients with respiratory failure and patients without respiratory involvement were 63%/47% and 64%/46% respectively (p-value=0.4). The mean age in these two groups were 2.7 +/- 1.9 and 5.5 +/- 3.2(P=0.003). Cranial nerve involvement (7, 9, 10) was recorded in patients with respiratory failure and without respiratory failure 54% and 25% respectively (P=0.03). Absent upper limb deep tendon reflexes in these two groups were 70% and 44% respectively (P=0.03) and autonomic nervous system involvement 24% vs. 14% (P=0.3). Conclusion This study suggests that younger age, cranial nerve involvement and absent upper limb deep tendon reflexes are predictive factors of respiratory failure in patients with Guillain-Barre Syndrome (GBS).