Management, morbidity and mortality of Guillain Barré Syndrome patients admitted to ICU at Universitas Academic Hospital
Diale, Mamonokane Innocentia
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Background: Guillain Barré Syndrome is the commonest cause of acute flaccid paralysis. It is an autoimmune post-infectious disorder that is monophasic and has good prognosis. However, a third of hospitalised patients with GBS are admitted to ICU with respiratory failure or dysautonomia. ICU mortality and morbidity has been associated with prolonged ICU stay of more than nine days and mechanical ventilation. Objective: The main aim of the study was to describe the clinical presentation, ICU management, complications and outcome of patients with Guillain Barré Syndrome requiring ICU management at the Universitas Academic Hospital, Free State Province of South Africa. Methods: The study was a retrospective observational study. A medical audit was carried out in all patients above the age of 13 years admitted to ICU at UAH with a diagnosis of GBS or AIDP. Telephonic interviews were also conducted to follow up on disease progression post discharge from hospital. Results: Twenty-six patients were included in the study. The median age was 30 years (range 13-77 years), males were predominant (65.8%) and black ethnicity comprised 83.3% of the patients. The median length of ICU stay was 9 days (range 1-140 days). The main indicator for ICU admission was respiratory monitoring (73%) followed by both respiratory monitoring and dysautonomia (26%) and dysautonomia (4%). Seventeen of the 25 (68%) patients were intubated and 11/17 (65%) had a tracheostomy for prolonged intubation. All patients were treated with intravenous immunoglobulin and four patients had additional immunosuppressive therapy. Eighteen patients (69,2%) had comorbidities with HIV infection being the commonest. Nineteen patients (73%) had complications that included prolonged ICU stay of more than nine days, mechanical ventilation, electrolyte imbalance, hypoalbuminaemia, anaemia, ventilator associated pneumonia and sepsis. The median ICU stay for patients with complications was 14 days (range 3-140 days) and for patients without complications was 3 days (range 1-7 days) (p<0.01). The serious complication rate was 88.9% in HIV infected patients versus 64.7% in HIV non-infected patients (p = 0.357). The use of traditional medicine was associated with a high complication rate, especially hepatic and multi-organ failure. Four ICU managed patients died. Conclusion: Prolonged ICU stay was associated with multiple complications. There was no significant difference between patients with co-morbidities and those without co-morbidities in terms of length of ICU stay and complications.