Critical Care Medicine 52(11):p
1781-1789, November 2024.
OBJECTIVES:
Guillain-Barré syndrome (GBS) and myasthenia gravis (MG) are
the most common causes of acute neuromuscular respiratory failure resulting in
ICU admission. This synthetic narrative review summarizes the evidence for the
prediction and management of acute neuromuscular respiratory failure due to GBS
and MG.
DATA SOURCES:
We searched PubMed for relevant literature and reviewed
bibliographies of included articles for additional relevant studies.
STUDY SELECTION:
English-language publications were reviewed.
DATA EXTRACTION:
Data regarding study methodology, patient population,
evaluation metrics, respiratory interventions, and clinical outcomes were
qualitatively assessed.
DATA SYNTHESIS:
No single tool has sufficient sensitivity and specificity
for the prediction of acute neuromuscular respiratory failure requiring
mechanical ventilation. Multimodal assessment, integrating history, examination
maneuvers (single breath count, neck flexion strength, bulbar weakness, and
paradoxical breathing) and pulmonary function testing are ideal for risk
stratification. The Erasmus GBS Respiratory Insufficiency Score is a validated
tool useful for GBS. Noninvasive ventilation can be effective in MG but may not
be safe in early GBS. Airway management considerations are similar across both
conditions, but dysautonomia in GBS requires specific attention. Extubation
failure is common in MG, and early tracheostomy may be beneficial for MG.
Prolonged ventilatory support is common, and good functional outcomes may occur
even when prolonged ventilation is required.
CONCLUSIONS:
Multimodal assessments integrating several bedside
indicators of bulbar and respiratory muscle function can aid in evidence-based
risk stratification for respiratory failure among those with neuromuscular
disease. Serial evaluations may help establish a patient’s trajectory and to
determine timing of respiratory intervention.
No comments:
Post a Comment