Guillain-Barre Syndrome is the most common cause of acute-onset neuromuscular weakness requiring ICU admission. COVID-19 appears to be one trigger of Guillain-Barre Syndrome, so this might be even more common in the coming months. There isn't much high-quality evidence regarding respiratory support in Guillain-Barre Syndrome, particularly when intubation is indicated. Consequently, it's important to use basic critical care principles and common sense, rather than artificial “rules” which are widely propagated in the literature.
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Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.
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Any evidence on checking how high a patient can count (e.g. “take a big breath in and start counting up as high as you can…1,2,3,4…”) as a surrogate for the FVC? I was taught that being able to count to 20 roughly correlated with a 2L VC and counting to 10 correlated with ~1L VC. It’s imprecise for exact measurements, but if nothing else the trend would be a useful and easy-to-perform metric for disease progression.
I’d like to know how others do the single breath count. I can’t do 20 at 1/second, so I think the patient is supposed to count fairly fast. What are others doing? Also, I thought the discussion was more “proBiPAP” than some others … in general I have heard BiPAP is popular in MG and unpopular in GBS due to tempo, bulbar/secretions, dysautonomia. Again, amazing website and discussion. How Josh does this and a full time job is beyond me.
Hi, yes I agree that the diaphragm strength does not correlate with upper extremity in general,particularly the distal parts, but it does correlates with the deltoid which shares some of the roots with the diaphragm (C 4). therefore, deltoid (shoulder abduction) and neck flexion probably can help in gauging the strength of the diaphragm.
an outstanding educational platform. a lot of thanks from Tripoli, Libya
Hi, yes I agree that the diaphragm strength does not correlate with upper extremity in general, but it does correlate with the deltoid which shares some of the roots with the diaphragm (C 4). therefore, deltoid (shoulder abduction) and neck flexion probably can help in gauging the strength of the diaphragm. thanks for this superb educational platform
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in Australia, DD includes unrecognized snake bite, and progressing tick paralysis