Syed Mushtaq Gilani.
Mechanical Ventilation in the Management of Guillain-Barre Syndrome in ICU.
J Ayub Med Coll Abottabad Jan ;12(1):53-4.

Case I: A young student, aged 18 years, was admitted in the hospital with the history of fever for two weeks and difficulty in walking with sudden weakness and numbness in both upper and lower limbs since two days. After thorough clinical examination proper investigation, the patient was diagnosed as a case of Guillain-Barre syndrome. On the third day of his admission it was observed that the patient was not breathing adequately and almost had a respiratory arrest. He was intubated with Portex endotracheal tube and put on Critical Care ventilator. The patient was weaned off the ventilator on the ninth day and later on extubated. Subsequently he did not do well on spontaneous respiration and was not able to maintain his vital signs hence was reintubated and put on the ventilator. Patient was sedated by intermittent diazepam / morphine and psychotherapy. After the two weeks of his admission he was put on IMV. His chest infection was managed by chest physiotherapy and regular endotracheal suction by fibreoptic bronchoscope. On twentieth day of admission patient was weaned off the ventilator and endotracheal tube removed on 27th day. He was maintained on naso gastric tube feeding throughout till he started taking oral semisolid diet in 6th week. He was never catheterised during his stay in ICU, only condom drainage was done. Mother of the patient was allowed to stay with the patient for nursing care and communication. Patient was discharged after 7 weeks with advice of repeated physiotherapy. He was doing well and happy to have achieved a new life with the help of ventilator and ICU staff.

Case II: An adult patient of forty years was transferred from the neurology ward to ICU with the diagnosis of GB syndrome. He developed tachypnea and respiratory difficulty and was put on Critical Care Ventilator. ET tube was changed every two days. On the eleventh day of admission to ICU, patient developed hypotension arid did not pass urine. He was put on Dopamine drip. Patient could not maintain his BP despite the drugs and went into cardiac arrest during the night of 12th day. Resuscitation measures were tried but he could not be revived.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com