MANAGEMENT AND OUTCOME OF SEVERE GUILLAIN-BARRE-SYNDROME

Seventy-nine patients with Guillain-Barre syndrome admitted to a neuro logical intensive therapy unit (ITU) between 1985 and 1992 were studie d retrospectively. The mean age was 49.8 years (range 16-86) and the t ime between the first neurological symptom and admission to ITU was 10 .2 days (0-62). Admission was precipitated by a combination of respira tory failure requiring ventilatory support (73.4%), bulbar weakness (5 7.0%), autonomic features (11.4%) and general medical factors (10.1%). Specific treatments included plasma exchange (65.8%), intravenous imm unoglobulin (13.9%) and methylprednisolone/placebo (12.7%). Significan t complications included lower respiratory tract infections (45.6%), h yponatraemia (25.3%), dysautonomia (19.0%), urinary tract infection (1 2.7%) and cognitive disturbances (8.9%). Four patients (5.1%) died dur ing the acute illness. Duration of nadir correlated with duration of v entilation, duration of ITU stay and outcomes at 3 months, 6 months an d 1 year. However, time to nadir, an indicator of rapidity of deterior ation, did not correlate with any outcome. The low mortality in this s eries of acutely ill and severely disabled patients suggests that spec ialized intensive therapy units continue to have an important role in the management of acutely ill patients with Guillain-Barre syndrome.