Purpose: To examine the effects of age on differences in the clinical course and functional outcome of mechanically ventilated Guillain-Barré syndrome (GBS) patients. Methods: 32 consecutive patients with GBS in need of mechanical ventilation were divided into two groups: (1) 15 patients <65 years, and (2) 17 patients ≥65 years. Length of ventilation, therapy, incidence of bulbar involvement, dysautonomia, preceding infections, need for tracheostomy, mortality, and functional outcome at 1-year follow-up using the Hughes outcome scale were analyzed. Results: The groups were comparable regarding treatment, lesion type, incidence of bulbar involvement, dysautonomia, preceding infections and duration of ventilation. The majority of patients (75%) received combination therapy (intravenous immunoglobulin and plasma exchange). Tracheostomy was performed in 91% of patients. Mortality was higher in older patients (41 vs. 7%; p = 0.02) and overall outcome worse (p = 0.05). Interestingly, once surviving the early, most critical period, older patients functionally recovered as well as younger patients (80% good outcome vs. 86%; p = 0.71). Conclusions: Despite all the advances in intensive care, mortality in older, ventilated GBS patients is still substantial. However, once they have survived the early, most critical period, older patients may recover as well as younger patients. Special care should therefore be taken to prevent and, if present, to vigorously treat complications commonly associated with intensive care treatment of severe GBS in elderly patients.

Keywords:
Guillain-Barré syndrome, Neuromuscular diseases, Neurocritical care, Ventilation
1.
Lawn ND, Fletcher DD, Henderson RD, Wolter TD, Wijdicks EF: Anticipating mechanical ventilation in Guillain-Barré syndrome. Arch Neurol 2001;58:893–898.
2.
Ropper AH: Unusual clinical variants and signs in Guillain-Barré syndrome. Arch Neurol 1986;43:1150–1152.
3.
Winer JB, Hughes RA, Greenwood RJ, Perkin GD, Healy MJ: Prognosis in Guillain-Barré syndrome. Lancet 1985;i:1202–1203.
4.
Winer JB, Hughes RA, Osmond C: A prospective study of acute idiopathic neuropathy. I. Clinical features and their prognostic value. J Neurol Neurosurg Psychiatry 1988;51:605–612.
5.
Lawn ND, Wijdicks EF: Fatal Guillain-Barré syndrome. Neurology 1999;52:635–638.
6.
Fletcher DD, Lawn ND, Wolter TD, Wijdicks EF: Long-term outcome in patients with Guillain-Barré syndrome requiring mechanical ventilation. Neurology 2000;54:2311–2315.
7.
Diener HC, Haupt WF, Kloss TM, Rosenow F, Philipp T, Koeppen S, Vietorisz A: A preliminary, randomized, multicenter study comparing intravenous immunoglobulin, plasma exchange, and immune adsorption in Guillain-Barré syndrome. Eur Neurol 2001;46:107–109.
8.
De Rooij SE, Abu-Hanna A, Levi M, de Jonge E: Factors that predict outcome of intensive care treatment in very elderly patients: a review. Crit Care 2005;9:R307–R314.
9.
Chelluri L, Grenvik A, Silverman M: Intensive care for critically ill elderly: mortality, costs, and quality of life. Review of the literature. Arch Intern Med 1995;155:1013–1022.
10.
Kass JE, Castriotta RJ, Malakoff F: Intensive care unit outcome in the very elderly. Crit Care Med 1992;20:1666–1671.
11.
Hennessy D, Juzwishin K, Yergens D, Noseworthy T, Doig C: Outcomes of elderly survivors of intensive care: a review of the literature. Chest 2005;127:1764–1774.
12.
Cheng BC, Chang WN, Chang CS, Tsai NW, Chang CJ, Hung PL, Wang KW, Chen JB, Tsai CY, Hsu KT, Chang HW, Lu CH: Predictive factors and long-term outcome of respiratory failure after Guillain-Barré syndrome. Am J Med Sci 2004;327:336–340.
13.
Dhar R, Stitt L, Hahn AF: The morbidity and outcome of patients with Guillain-Barré syndrome admitted to the intensive care unit. J Neurol Sci 2008;264:121–128.
14.
Hughes RA, Cornblath DR: Guillain-Barré syndrome. Lancet 2005;366:1653–1666.
15.
Asbury AK, Cornblath DR: Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol 1990;27(suppl):S21–S24.
16.
Hadden RD, Cornblath DR, Hughes RA, Zielasek J, Hartung HP, Toyka KV, Swan AV; Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group: Electrophysiological classification of Guillain-Barré syndrome: clinical associations and outcome. Ann Neurol 1998;44:780–788.
17.
Flachenecker P, Wermuth P, Hartung HP, Reiners K: Quantitative assessment of cardiovascular autonomic function in Guillain-Barré syndrome. Ann Neurol 1997;42:171–179.
18.
Chelluri L, Pinsky MR, Donahoe MP, Grenvik A: Long-term outcome of critically ill elderly patients requiring intensive care. JAMA 1993;269:3119–3123.
19.
Hughes RA, Newsom-Davis JM, Perkin GD, Pierce JM: Controlled trial prednisolone in acute polyneuropathy. Lancet 1978;2:750–753.
20.
Wood KA, Ely EW: What does it mean to be critically ill and elderly? Curr Opin Crit Care 2003;9:316–320.
21.
Ng KK, Howard RS, Fish DR, Hirsch NP, Wiles CM, Murray NM, Miller DH: Management and outcome of severe Guillain-Barré syndrome. QJM 1995;88:243–250.
22.
Lawn ND, Wijdicks EF: Tracheostomy in Guillain-Barré syndrome. Muscle Nerve 1999;22:1058–1062.
23.
Wijdicks EF, Borel CO: Respiratory management in acute neurologic illness. Neurology 1998;50:11–20.
24.
Aggarwal AN, Gupta D, Lal V, Behera D, Jindal SK, Prabhakar S: Ventilatory management of respiratory failure in patients with severe Guillain-Barré syndrome. Neurol India 2003;51:203–205.
25.
Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group: Randomised trial of plasma exchange, intravenous immunoglobulin, and combined treatments in Guillain-Barré syndrome. Lancet 1997;349:225–230.
26.
Hughes RA, Raphael JC, Swan AV, Doorn PA: Intravenous immunoglobulin for Guillain-Barré syndrome. Cochrane Database Syst Rev 2004:CD002063.
27.
Raphael JC, Chevret S, Hughes RA, Annane D: Plasma exchange for Guillain-Barré syndrome. Cochrane Database Syst Rev 2002:CD001798.
28.
Hughes RA, Wijdicks EF, Barohn R, Benson E, Cornblath DR, Hahn AF, Meythaler JM, Miller RG, Sladky JT, Stevens JC: Practice parameter: immunotherapy for Guillain-Barré syndrome: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2003;61:736–740.
29.
Henderson RD, Lawn ND, Fletcher DD, McClelland RL, Wijdicks EF: The morbidity of Guillain-Barré syndrome admitted to the intensive care unit. Neurology 2003;60:17–21.
30.
Campion EW, Mulley AG, Goldstein RL, Barnett GO, Thibault GE: Medical intensive care for the elderly. A study of current use, costs, and outcomes. JAMA 1981;246:2052–2056.
31.
Rees JH, Thompson RD, Smeeton NC, Hughes RA: Epidemiological study of Guillain-Barré syndrome in south east England. J Neurol Neurosurg Psychiatry 1998;64:74–77.
32.
Newton-John H: Prevention of pulmonary complications in severe Guillain-Barré syndrome by early assisted ventilation. Med J Aust 1985;142:444–445.
33.
Koeppen S, Kraywinkel K, Wessendorf TE, Ehrenfeld CE, Schurks M, Diener HC, Weimar C: Long-term outcome of Guillain-Barré syndrome. Neurocrit Care 2006;5:235–242.
© 2009 S. Karger AG, Basel
2009
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.