Up to 25% pf patients with Guillain-Barré will develop respiratory failure. Close monitoring and proactive management are key – however, do not assume all cases are due to neuromuscular dysfunction. Other causes of respiratory failure should be excluded (or treated!).
There is limited evidence for the use of non-invasive BiPAP or high flow nasal oxygen therapy, but a trial of either may be considered to reduce work of breathing.
Autonomic dysfunction is a concerning sign and should prompt critical care referral for ongoing management. Fluctuations are common, so caution should be used if treating hypertension, to avoid precipitating subsequent refractory hypotension – short acting agents are advised if the hypertension must be treated.
Caution with spirometry in cases involving facial weakness, as this weakness can affect the lip-grip on the spirometry mouth piece, causing inaccurate results.
Specific management involves either plasma exchange or IV immunoglobulins.
There is no evidence to suggest steroids are effective.
Critical care admission may be prolonged, so supportive care is vitally important, including nutrition, effective analgesia, early physiotherapy, VTE prophylaxis and psychological support.
