Selective Immune Adsorption Treatment of Severe Guillain Barré Syndrome in the Intensive Care Unit

Background The effectiveness of plasma exchange and intravenous application of immunoglobulins (IVIG) for the treatment of the Guillain Barré syndrome (GBS) has been demonstrated in large collectives. In contrast, there are only a few investigations in GBS patients with severe symptoms admitted to t...

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Bibliographic Details
Published in:Neurocritical care 2009-12, Vol.11 (3), p.317-321
Main Authors: Galldiks, N., Dohmen, C., Neveling, M., Fink, G. R., Haupt, W. F.
Format: Article
Language:English
Subjects:
Adult
Aged
Antibodies
Apheresis
Combined Modality Therapy
Critical Care Medicine
Female
Guillain-Barre syndrome
Guillain-Barre Syndrome - immunology
Guillain-Barre Syndrome - therapy
Humans
Immunoglobulins, Intravenous - administration & dosage
Immunosorbent Techniques
Immunotherapy - methods
Intensive
Intensive care
Intensive Care Units
Internal Medicine
Male
Medicine
Medicine & Public Health
Middle Aged
Neurology
Original Article
Patients
Plasma
Polyvinyl alcohol
Retrospective Studies
Severity of Illness Index
Treatment Outcome
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Summary:Background The effectiveness of plasma exchange and intravenous application of immunoglobulins (IVIG) for the treatment of the Guillain Barré syndrome (GBS) has been demonstrated in large collectives. In contrast, there are only a few investigations in GBS patients with severe symptoms admitted to the intensive care unit (ICU) and treated with selective immune adsorption (SIA). We compared the efficacy and safety of SIA only versus SIA followed by IVIG in patients with severe GBS. Methods Patients with severe GBS admitted to the ICU were treated with SIA only or in combination with IVIG. Severity of symptoms was assessed using Hughes grades and severe GBS was defined as ≥3. Data were acquired retrospectively for the last 10 years (1998–2008). Results Data from 30 GBS patients (age 53 ± 16 years) with severe symptoms (Hughes grade 5: 30% [ n  = 9], grade 4: 57% [ n  = 17], grade 3: 13% [ n  = 4]) were analyzed. The mean Hughes grade at admission was 4.2 ± 0.7. Ten patients were treated by SIA only, 20 patients were treated sequentially with SIA followed by IVIG (30 g/d) over 3 days. The number of SIA sessions was 3.2 ± 0.8. Improvement of Hughes grade 4.2 ± 0.7 to 3.4 ± 0.9 ( P  
ISSN:1541-6933
1556-0961
DOI:10.1007/s12028-009-9252-6