Abstract

Introduction

Up to 30% of patients with Guillain–Barré syndrome (GBS) develop respiratory failure requiring intensive care unit (ICU) admission and mechanical ventilation. Progressive weakness of the respiratory muscles is the leading cause of acute respiratory distress and respiratory failure with hypoxia and hypercarbia. Bulbar weakness may compromise airway patency and predispose patients to aspiration pneumonia. Mechanical ventilation is often necessary for patients with severe GBS. All references were selected from PubMed, Google Scholar, Cochrane database, and Web of Science; most were published between 2010 and 2020.Areas covered: Clinical questions related to the use of mechanical ventilation include but are not limited to: When to start? Invasive or non-invasive? When and how to wean? When to perform tracheostomy? Complications of GBS in the ICU including nosocomial infection, ventilator-associated pneumonia, and intensive care unit-acquired weakness may aggravate the disease and prolong mechanical ventilation and ICU stay. In this narrative review, the authors summarize the up-to-date knowledge of the incidence, pathophysiology, evaluation, and general management of respiratory failure in GBS. Expert opinion: Respiratory failure in GBS merits more attention from caregivers. Emergency intubation may lead to life-threatening complications. Advanced ventilation modes, intubation equipment, and tracheostomy methodologies have emerged in recent years. Appropriate methods and time point of intubation and weaning, an early tracheostomy, and predictive prophylaxis of complications benefit patients’ long-term prognosis.

中文翻译：

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吉兰-巴雷综合征的机械通气

摘要

介绍

多达 30% 的格林-巴利综合征 (GBS)患者会出现呼吸衰竭，需要入住重症监护病房 (ICU) 并进行机械通气。呼吸肌的进行性无力是急性呼吸窘迫和呼吸衰竭伴缺氧和高碳酸血症的主要原因。延髓无力可能会影响气道通畅，并使患者易患吸入性肺炎。重度 GBS 患者通常需要机械通气。所有参考文献均选自 PubMed、Google Scholar、Cochrane 数据库和 Web of Science；大部分被2010年和2020年间出版的涵盖领域：与使用机械通气相关的临床问题包括但不限于：何时开始？侵入性还是非侵入性？何时以及如何断奶？什么时候进行气管切开术？ICU 中 GBS 的并发症包括医院感染、呼吸机相关性肺炎和重症监护病房获得性虚弱，可能会加重病情并延长机械通气和 ICU 住院时间。在这篇叙述性综述中，作者总结了 GBS 呼吸衰竭的发病率、病理生理学、评估和一般管理的最新知识。专家意见：GBS 中的呼吸衰竭值得护理人员更多关注。紧急插管可能会导致危及生命的并发症。近年来出现了先进的通气模式、插管设备和气管切开术方法。适当的插管和撤机方法和时间点、早期气管切开术和并发症的预测性预防有益于患者的长期预后。