Tracheostomy in Guillain-Barre syndrome

Specific treatment has been shown to shorten the duration of mechanical ven tilation in Guillain-Barre syndrome (GBS) and could obviate the need for tr acheostomy in a significant proportion of patients. However, the factors pr edictive of prolonged ventilation are undetermined, and the timing and use of tracheostomy in patients with GBS have not been systematically studied. The medical records of 60 patients ventilated for GBS were reviewed. Only 1 3 patients (22%) could be weaned within 3 weeks. Patients ventilated longer were significantly older (P = 0.04), and 21% had underlying pulmonary dise ase. Median duration of ventilation in patients treated with plasma exchang e (n = 31) was not shortened. Fifty-two patients (87%) received a tracheost omy at a median of 9 days after intubation. In this series, where patients with comorbidity were included, tracheostomy was still necessary in the maj ority of ventilated patients. This procedure can be anticipated in elderly patients and in the presence of preexisting pulmonary disease. (C) 1999 Joh n Wiley & Sons, Inc.