Plasmaféresis en el síndrome de Guillain Barre: Presentación de tres casos

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Abstract

Se presentan tres casos con Síndrome de Guillain Barre, admitidos en la unidad de cuidados intensivos del Hospital Provincial Manuel Ascunce Domenech desde julio a septiembre de 2003. La infección respiratoria y gastrointestinal de causa viral precedió el cuadro en dos casos. Posterior a la debilidad muscular y parálisis progresiva de extremidades, apareció marcada dificultad respiratoria con necesidad de ventilación mecánica artificial en dos pacientes. La plasmaféresis permitió una recuperación rápida de la severidad de los síntomas. A partir de la quinta plasmaféresis se logró una ventilación espontánea, y antes de ella, una mejoría motora. Los pacientes se recuperaron completamente dos meses después de la rehabilitación y la fisioterapia, y fueron seguidos durante seis meses sin recaídas.

Translated abstract

Three cases of Guillain Barre's syndrome are presented, they were admitted in the intensive care unit of Manuel Ascunce Domenech Provincial Hospital from July to September, 2003. Breathing and gastrointestinal infection of viral etiology preceded the picture in two cases. Affter muscular weakness and progressive paralysis of limbs, a marked breathing difficulty appeared with necessity of artificial mechanical ventilation in two cases. Plasmapheresis allowed a rapid recovering from severity of symptoms. Starting from the fifth plasmapheresis, it was achieved a spontaneous ventilation and previous to it, a motor improvement. The totality of patients survived with complete recovery two months after rehabilitation and physiotherapy. Patients were followed up during six months without relapses.

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Most cited references 11

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Warning signs of imminent respiratory failure in neurological patients.

Alejandro A Rabinstein, Eelco Wijdicks (2003)

Critically ill neurological patients often need ventilatory assistance. After acute central nervous system insults, the inability to protect the airway and impaired central respiratory drive can only be managed with endotracheal intubation and mechanical ventilation. In patients with acute or worsening neuromuscular disorders, diaphragmatic failure and pronounced bulbar weakness may necessitate intubation to assist in the work of breathing or to prevent upper airway obstruction. Simple respiratory function tests performed at the bedside should be used to monitor patients with progressive neuromuscular respiratory insufficiency. Noninvasive positive pressure ventilation plays an important role in the management of respiratory failure in patients with neuromuscular respiratory failure, and its indications may be expanded in the future.