2. Management
Early:
• Regular monitoring of respiratory function
• Monitoring of O2 saturation
• Heparin 5000 units SC bid
• Chest physiotheraphy
• Ryles tube feeding if there is bulbar weakness
• IV immunoglobulin – 0.4/kg/day for 5 days
• Consider plasma exchange (plasma exchange 40-50 ml/kg- 4 times a week)
(Active treatment with plasma exchange or IV immunoglobulin therapy shorten
duration of ventilation and improves prognosis)
• Supportive measures prevent pressure sores, keratitis, DVT, vigilance of
hyponatraemia and other electrolytes and prompt management of cardiac
arrhytmias.
3. Management
Late
Ventilatory assistance if VC ,24ml/kg
Mechanical ventilation is required in:
Severe weakness on admission
A rapid tempo of progression
Presence of facial and/or bulbar weakness during first week of symptoms
Tracheostomy- for prolonged ventilatory assistance > 14 days
Cardiac pacemaker for episodes of bradycardia/cardiac asystole
Physiotheraphy
Occupational theraphy
In severe GBS, both ntravenonus immunoglobulin (IVIg) and plasma exchange started within 2 weeks
of onset hasten recovery with similar rates of adverse effects.
4. PROGNOSIS
85% of patients achieve a full functional recovery within several months to a year, although
minor findings on examination (such as areflexia) may persist and patients often complain of
continued symptoms, including fatigue.
The mortality rate is <5% in optimal settings; death usually results from secondary
pulmonary complications.
The outlook is worst in patients with severe proximal motor and sensory axonal damage.
Other factors that worsen the outlook for recovery are advanced age, a fulminant or severe
attack, and a delay in the onset of treatment.
Between 5 and 10% of patients with typical GBS have one or more late relapses; many of
these cases are then classified as chronic inflammatory demyelinating polyneuropathy (CIDP).
