Plasmaféresis por método de filtración de membrana para el Síndrome de Guillain-Barre

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Abstract

Fundamento: la plasmaféresis por método de filtración de membrana es un tratamiento eficaz para pacientes con síndrome de Guillain-Barre grave. Objetivo: demostrar las ventajas de la plasmaféresis por filtración de membrana en el tratamiento de las formas graves del síndrome de Guillain-Barre. Método: se realizó un estudio prospectivo descriptivo en la unidad de terapia intensiva del Hospital Universitario Manuel Ascunce Domenech de Camagüey, desde enero de 2007 a enero de 2011. La muestra fue de 23 pacientes con diagnóstico de síndrome de Guillain-Barre con parálisis respiratoria. Se utilizó para la plasmaféresis una máquina de hemodiálisis convencional Fresenius 4008-D, filtros de plasma y líneas sanguíneas para hemodiálisis. Los volúmenes de plasma extraídos fueron de 3000 ml, se utilizaron como soluciones de reemplazo albúmina humana y plasma fresco, la información fue recogida en planillas a partir de las historias clínicas, se procesaron las frecuencias relativas y porcentajes de las variables. Resultados: la recuperación de la fuerza muscular fue significativa y la rápida salida de la ventilación de los pacientes después de las primeras cinco sesiones. Se presentaron pocas complicaciones. El tratamiento fue efectivo para el 95,6 % de los pacientes. Conclusiones: el tratamiento fue efectivo, la mejoría se obtuvo después de los cinco recambios, el tiempo necesario para obtener el volumen plasmático deseado fue de una hora y media a dos horas y media, más rápido que por el método de centrifugación, redujo el tiempo de recuperación de la fuerza muscular y de la ventilación mecánica, resultó ser, además, una técnica segura y rápida para el paciente que padece de esta enfermedad.

Translated abstract

Background: plasmapheresis by membrane filtration method is an effective treatment for patients with serious Guillain-Barré syndrome. Objective: to demonstrate the advantages of plasmapheresis by membrane filtration in the treatment of severe Guillain-Barré syndrome. Methods: a prospective and descriptive study was conducted in the intensive care unit at the Provincial Hospital Manuel Ascunce Domenech, Camaguey; from January 2007 to January 2011. The sample was composed of 23 patients with diagnosis of Guillain-Barré syndrome with respiratory paralysis. For plasmapheresis was used a conventional haemodialysis machine Fressenius 4008-D, and plasma filters and blood lines for haemodialysis. Extracted plasma volumes were about 3000 ml, as replacement solutions albumin human and fresh plasma were used. The information was collected in forms from clinical histories, relative frequencies and percentages of variables were processed. Results: the recovery of muscle strength was significant and the quick exit of the ventilation of patients after the first five sessions. Few complications were presented. The treatment was effective for 95, 65 % of patients. Conclusions: the treatment was effective; improvement was obtained after five exchange transfusions; the needed time to obtain the desired plasma volume was on an hour and a half to two hours and a half, quicker than the centrifugation method. It reduced the time of recovery of muscle strength and mechanical ventilation, turned out to be, in addition, a safe and quick technique for patients who suffer from this disease.

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Most cited references 24

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The spectrum of antecedent infections in Guillain-Barré syndrome: a case-control study.

B Jacobs, P H Rothbarth, F.G.A. van der Meche … (1998)

To determine which antecedent infections are specifically associated with the Guillain-Barré syndrome (GBS). Infections with many agents have been reported preceding GBS. Some infections are related to specific clinical and immunologic subgroups in GBS. Most agents were reported in case reports and uncontrolled small series of GBS patients only, and their relation to GBS and its subgroups remains unclear. A serologic study for 16 infectious agents in 154 GBS patients and 154 sex- and age-matched controls with other neurologic diseases. Acute phase, pretreatment samples were used from clinically well-defined GBS patients. The seasonal distribution of serum sampling in the GBS and control group was the same. Multivariate analysis showed that in GBS patients, infections with Campylobacter jejuni (32%), cytomegalovirus (13%), and Epstein-Barr virus (10%) were significantly more frequent than in controls. Mycoplasma pneumoniae infections occurred more often in GBS patients (5%) than in controls in univariate analysis. Infections with Haemophilus influenzae (1%), parainfluenza 1 virus (1%), influenza A virus (1%), influenza B virus (1%), adenovirus (1%), herpes simplex virus (1%), and varicella zoster virus (1%) were also demonstrated in GBS patients, but not more frequently than in controls. C. jejuni infections were associated with antibodies to the gangliosides GM1 and GD1b and with a severe pure motor form of GBS. Cytomegalovirus infections were associated with antibodies to the ganglioside GM2 and with severe motor sensory deficits. Other infections were not related to specific antiganglioside antibodies and neurologic patterns. Recent infections with C. jejuni, cytomegalovirus, Epstein-Barr virus, and M. pneumoniae are specifically related to GBS. The variety of infections may contribute to the clinical and immunologic heterogeneity of GBS.

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Guillain-Barré syndrome.

F. Hahn (1998)

Guillain-Barré syndrome (GBS) is viewed as a reactive, self-limited, autoimmune disease triggered by a preceding bacterial or viral infection. Campylobacter jejuni, a major cause of bacterial gastroenteritis worldwide, is the most frequent antecedent pathogen. It is likely that immune responses directed towards the infecting organisms are involved in the pathogenesis of GBS by cross-reaction with neural tissues. The infecting organism induces humoral and cellular immune responses that, because of the sharing of homologous epitopes (molecular mimicry), cross-react with ganglioside surface components of peripheral nerves. Immune reactions against target epitopes in Schwann-cell surface membrane or myelin result in acute inflammatory demyelinating neuropathy (85% of cases); reactions against epitopes contained in the axonal membrane cause the acute axonal forms of GBS (15% of cases). Care for such patients may be challenging, yet the prognosis overall is favourable. Optimal supportive care and anticipation and prevention of complications are the mainstay of therapy. Admission to the intensive-care unit is necessary in 33% of patients who require intubation and assisted ventilation. Immunomodulation with infusions of IgG or plasma exchange treatments foreshorten the disease course.

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Guillain-Barré syndrome.

R Warren, Dana Newswanger (2004)

Guillain-Barré syndrome (GBS) is a group of autoimmune syndromes consisting of demyelinating and acute axonal degenerating forms of the disease. Nerve conduction study helps differentiate the heterogeneous subtypes of GBS. Patients exhibit a progressive paralysis that reaches a plateau phase. In most patients, resolution is complete or near complete. Mortality from GBS most often is associated with dysautonomia and mechanical ventilation. GBS usually is associated with an antecedent infection by one of several known pathogens. Cross-reactivity between the pathogen and the nerve tissue sets up the autoimmune response. Treatment consists of supportive care, ventilatory management (in about one third of patients), and specific therapy with intravenous immunoglobulin or plasmapheresis. Consultation with a neurologist is suggested.