Intubation predictors in GBS

Q: All of the following are the predictors of intubation in Guillain-Barre Syndrome (GBS) Except?

A) Liver enzyme increases
B) Inability to stand
C) Inability to lift the elbows
D) Inability to lift the head
E) Serum creatinine increases


Answer: E

In a large prospective study of 722 patients published in 2003, it showed that out of the following six, if four are present - intubation is predicted in 85% of the cases

1. Time of onset to admission less than seven days 
2. Inability to cough 
3. Inability to stand 
4. Inability to lift the elbows 
5. Inability to lift the head 
6. Liver enzyme increases

Objectively, following parameters are very good predictors of impending respiratory failure and advocate elective intubation in GBS patients

1. Forced vital capacity less than 20 mL/kg 
2. Maximum inspiratory pressure less than 30 cmH2O 
3. Maximum expiratory pressure less than 40 cmH2O

References:

1.  Sharshar T, Chevret S, Bourdain F, et al. Early predictors of mechanical ventilation in Guillain-Barré syndrome. Crit Care Med 2003; 31:278

2. Lawn ND, Fletcher DD, Henderson RD, et al. Anticipating mechanical ventilation in Guillain-Barré syndrome. Arch Neurol 2001; 58:893