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Comparison of intravenous immunoglobulin and plasma exchange in treatment of mechanically ventilated children with Guillain Barré syndrome: a randomized study

Mohammed A El-Bayoumi1*, Ahmed M El-Refaey2, Alaa M Abdelkader1, Mohamed MA El-Assmy1, Angi A Alwakeel1 and Hanem M El-Tahan1

Author Affiliations

1 Pediatric Intensive Care Unit, Mansoura University Children Hospital, Al-Gomhuria Street, Mansoura 35516, Egypt

2 Pediatric Nephrology Unit, Mansoura University Children Hospital, Al-Gomhuria Street, Mansoura 35516, Egypt

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Critical Care 2011, 15:R164  doi:10.1186/cc10305


See related commentary by Hughes, http://ccforum.com/content/15/4/174

Published: 11 July 2011

Abstract

Introduction

Respiratory failure is a life threatening complication of Guillain Barré syndrome (GBS). There is no consensus on the specific treatment for this subset of children with GBS.

Methods

This was a prospective randomized study to compare the outcome of intravenous immunoglobulin (IVIG) and plasma exchange (PE) treatment in children with GBS requiring mechanical ventilation. Forty-one children with GBS requiring endotracheal mechanical ventilation (MV) within 14 days from disease onset were included. The ages of the children ranged from 49 to 143 months.

Randomly, 20 children received a five-day course of IVIG (0.4 g/kg/day) and 21 children received a five-day course of one volume PE daily. Lumbar puncture (LP) was performed in 36 patients (18 in each group).

Results

Both groups had comparable age (p = 0.764), weight (p = 0.764), duration of illness prior to MV (p = 0.854), preceding diarrhea (p = 0.751), cranial nerve involvement (p = 0.756), muscle power using Medical Research Council (MRC) sum score (p = 0.266) and cerebrospinal fluid (CSF) protein (p = 0.606).

Children in the PE group had a shorter period of MV (median 11 days, IQR 11.0 to 13.0) compared to IVIG group (median 13 days, IQR 11.3 to 14.5) with p = 0.037.

Those in the PE group had a tendency for a shorter Pediatric Intensive Care Unit (PICU) stay (p = 0.094).

A total of 20/21 (95.2%) and 18/20 (90%) children in the PE and IVIG groups respectively could walk unaided within four weeks after PICU discharge (p = 0.606).

There was a negative correlation between CSF protein and duration of mechanical ventilation in the PE group (p = 0.037), but not in the IVIG group (p = 0.132).

Conclusions

In children with GBS requiring MV, PE is superior to IVIG regarding the duration of MV but not PICU stay or the short term neurological outcome.

The negative correlation between CSF protein values and duration of MV in PE group requires further evaluation of its clinical usefulness.

Trial Registration

Clinicaltrials.gov Identifier NCT01306578