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Influence of critical illness on axonal loss in Guillain–Barré syndrome
Author(s) -
Ho Doreen,
Thakur Kiran,
Gorson Kenneth C.,
Ropper Allan H.
Publication year - 2009
Publication title -
muscle and nerve
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.025
H-Index - 145
eISSN - 1097-4598
pISSN - 0148-639X
DOI - 10.1002/mus.21207
Subject(s) - critical illness polyneuropathy , medicine , guillain barre syndrome , intensive care unit , electromyography , severity of illness , mechanical ventilation , sepsis , critical illness , physical therapy , anesthesia , physical medicine and rehabilitation , critically ill , pediatrics
In this study we sought to determine whether axonal damage in severe Guillain–Barré syndrome (GBS) was secondary to critical illness polyneuropathy (CIP) in the intensive care unit (ICU) by reviewing comorbidities in patients who had initial and follow‐up electromyographic (EMG) studies. Patients were classified as demyelinating (EMG‐D) or axonal (EMG‐A) according to findings on the second EMG. A critical illness (CI) score, derived from components of the APACHE II score, assessed the severity of critical illness in the ICU. Forty‐one patients were admitted to the ICU and had a follow‐up EMG. Of these, 28 (68%) developed an EMG‐A pattern. There was no difference in the timing of the second EMG (mean, 23 days) between the two groups. The mean CI score (10.7 for EMG‐A vs. 9.2 for EMG‐D, P = 0.47) and frequency of sepsis (89% vs. 77%, P = 0.36) were similar between the groups. Mean strength (0–100, Medical Research Council scale) and Hughes disability scores for the EMG‐A group were significantly worse at admission, nadir, and discharge. EMG‐A patients had significantly more days on the ventilator (25 vs. 11), in the ICU (26 vs. 15), and in the hospital (29 vs. 18). Sixty‐eight percent of patients with GBS in the ICU developed axon loss, but this was not related to the usual precipitants of CIP. Muscle Nerve 39: 10–15, 2009