Gillian-Barre Syndrome: Causes, Symptoms, and Treatment

Diagnostic Tests 

Mainstay diagnostic work up for the 50 -year-old U.S. Navy Physician involves investigations on basic peripheral neuropathy through nerve conduction studies and needle electromyogram in addition to metabolic panel; under biochemistry, Liver function tests (LFTs), electrolyte level, and Creatine phosphokinase (CPK) level are essential investigations (Dosi et al., 2014 ). Baseline Erythrocyte sedimentation rate (ESR) is vital. Cerebrospinal fluid studies is crucial with reference to cell count and protein levels ( Walling & Dickson, 2013). He can also benefit from assessment of pulmonary function test and diagnostic imaging of the spine using Magnetic resonance imaging (MRI) ( Dosi et al., 2014 ). 

Symptoms Coinciding with Guillian – Barre’ Syndrome 

Tingling and burning sensations in his feet; radicular pain from his feet to knee; numbness of his leg; and acute onset of muscle weakness (Willison, Jacobs & Van Doorn, 2016). 

Interpretation of ABG 

The findings of ABG analysis gives the diagnosis of uncompensated respiratory acidosis since pH is reduced below 7.35 (lower limit of normal reference range) and PaCO 2 is elevated above 45mmHg (upper limit of normal reference range). HCO 3 levels are within normal reference ranges despite elevated levels of PaCO 2 indicating that no compensatory mechanism that are ongoing 

Indications for Intubation and Mechanical Ventilation in GBS 

Acute neuromuscular respiratory failure (Rabinstein, 2016). Presence of the six predictive factors of respiratory failure including time of onset to admission less than 7 days; inability to cough, stand, lift the elbows or the head; and liver enzyme elevation (Ayala & Rudkovskaia, 2016). Respiratory insufficiency (Walgaard et al., 2017). Lastly, Persistent uncompensated respiratory acidosis with PaCO 2 > 50mmHg and pH <7. 

ETT size and Ventilator Settings 

ETT size Internal Diameter (ID): Adult Male of 50 years: 8.0 - 8.5 mm. Ventilator settings: tidal volume of 6ml/kg, RR of 5-8, I/E ratio of 1:4, PEEP of 4, and FIO 2 of 1.0 

Interpretation of ABG, and the Cause 

Uncompensated respiratory alkalosis, pH is above 7.45 while PaCO 2 is below 35mmHg. HCO 3 is within normal reference range meaning no compensation is ongoing. The lower levels of PaCO 2 was caused by mechanical hyperventilation causing respiratory alkalosis. 

Changes to the Ventilator Settings 

Reducing the tidal volume to half 350ml, respiratory rate to 7/min from 14, and FIO 2 to 1.0. 

Protocol 

Respiratory care protocols. They are needed in order to avoid misallocation of respiratory care by either over-ordering (that is, prescribing respiratory care that is unlikely to confer benefit) or under-ordering services (that is, failing to prescribe services that would be expected to offer benefit) (Modrykamien & Stoller, 2013). 

Recommended Protocol (secretion present) 

Bronchopulmonary hygiene protocol. To prevent further aspiration and ventilator associated pneumonia 

Recommended Protocol (Last Question) 

Respiratory care weaning protocol. 

ETT and long term Mechanical Ventilation 

Endotracheal tube management entails close monitoring of the tube to ensure its patency, no skin breakdown from the tube and infection prevention especially of the lower respiratory tract (Gale, 2016) . Long term mechanical ventilation management encompass identification and correction of barriers to weaning, systematic approach to weaning trials, timing of when to cease weaning trials and proceeding to life-long support (White, 2012). 

RT Evaluation before Extubation 

Checking static and dynamic lung compliance; monitoring real time analysis of end-tidal CO 2 and carbon dioxide production (White, 2012). Finally assessment of the respiratory muscle strength 

Outcome 

Successful extubation 

References 

Ayala, J. P., & Rudkovskaia, A. (2016). An Adjunct To Intubation Criteria For Patients With Guillain-Barre Syndrome. Am J Respir Crit Care Med , 193 , A5324. 

Dosi, R., Ambaliya, A., Patel, N., Shah, M., & Patell, R. (2014). Acute multiple cranial neuropathy: An oculopharyngeal variant of Guillain-Barré Syndrome. The Australasian medical journal , 7 (9), 376. 

Gale, T. (2016). Endotracheal Tube Management. Retrieved from https://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/endotracheal-tube-management 

Modrykamien, A. M., & Stoller, J. K. (2013). The scientific basis for protocol-directed respiratory care. Respiratory care , 58 (10), 1662-1668. 

Rabinstein, A. A. (2016). Noninvasive ventilation for neuromuscular respiratory failure: when to use and when to avoid. Current opinion in critical care , 22 (2), 94-99. 

Walgaard, C., Lingsma, H. F., van Doorn, P. A., van der Jagt, M., Steyerberg, E. W., & Jacobs, B. C. (2017). Tracheostomy or not: prediction of prolonged mechanical ventilation in Guillain–Barré syndrome. Neurocritical care , 26 (1), 6-13. 

Walling, A. D., & Dickson, G. (2013). Guillain-Barré Syndrome. American family physician , 87 (3). 

White, A. C. (2012). Long-term mechanical ventilation: management strategies. Respiratory care , 57 (6), 889-899. 

Willison, H. J., Jacobs, B. C., & Van Doorn, P. A. (2016). Guillain-barre syndrome. The Lancet , 388 (10045), 717-727.