Long-term outcome in patients with Guillain-Barre syndrome requiring mechanical ventilation

Objective: To analyze long-term recovery and predictors of outcome in patie nts with Guillain-Barre syndrome (GBS) requiring mechanical ventilation. Me thods: The clinical and electrophysiologic data of 114 patients with GBS ad mitted to the intensive care unit between 1976 and 1996 (60 mechanically ve ntilated, 54 nonventilated) were reviewed. Functional disability and predic tors of outcome were determined at 1 year and at maximal recovery using the Hughes scale. Good outcome was defined as ability to ambulate without assi stance; poor outcome was defined as inability to ambulate independently. Re sults: Mechanical ventilation was required in 81% of patients with a poor o utcome. Mortality was 20% in patients ventilated for GBS. However, ventilat ed patients who survived did well, with 79% eventually regaining independen t ambulation. Nineteen percent of patients improved at least one functional grade beyond 1 year. Univariate predictors of poor maximal recovery in ven tilated 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 d ays to transfer to a tertiary center (p < 0.001). However, only age (OR 1.9 9, p = 0.004) and delayed transfer (OR 19.8, p = 0.002) were independently predictive of poor outcome on multivariate analysis. Conclusion: Mechanical ly 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 independe nt ambulation.