Tracheostomy or Not: Prediction of Prolonged Mechanical Ventilation in Guillain-Barré Syndrome.
Tracheostomy or Not: Prediction of Prolonged Mechanical Ventilation in Guillain-Barré Syndrome.
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DOI：
10.1007/s12028-016-0311-5
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发表时间：
2017-02
影响因子：
3.5
通讯作者：
Jacobs BC
中科院分区：
文献类型：
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作者：
Walgaard C;Lingsma HF;van Doorn PA;van der Jagt M;Steyerberg EW;Jacobs BC
20%的格林-巴利综合征（GBS）患者发生呼吸功能不全，机械通气（MV）的持续时间范围很广。我们确定了MV延长的预测因素，以指导临床气管切开术的决策。我们分析了在荷兰的两项临床试验和三项队列研究中从552例GBS患者中前瞻性收集的数据。使用交叉表考虑MV延长（定义为持续时间≥14天）的潜在预测因素。采用考克斯回归分析对选定的预测因子进行分析。在总共150例（27%）需要MV的患者中，106例（71%）患者需要延长MV。MV的中位持续时间为28天（四分位距[IQR] 12-60天）。观察到的MV延长的最强预测因素是肌无力和轴突变性或神经传导研究中的不可兴奋神经。插管后1周无法将手臂从床上抬起的患者（三角肌的双侧医学研究理事会[MRC]为0-2）有87%的机会需要延长MV，而能够将手臂从床上抬起的患者（三角肌的双侧MRC为3-10）有69%的机会需要延长MV。在最后一组中，在神经传导研究中有轴突变性或不可兴奋神经的患者也有90%的机会需要延长MV。无法从床上抬起手臂的GBS患者和1周时有轴突变性或不可兴奋神经的患者是MV延长的高风险，这些患者应考虑气管切开术。
Respiratory insufficiency occurs in 20 % of Guillain–Barré syndrome (GBS) patients, and the duration of mechanical ventilation (MV) ranges widely. We identified predictors of prolonged MV to guide clinical decision-making on tracheostomy. We analyzed prospectively collected data from 552 patients with GBS in the context of two clinical trials and three cohort studies in The Netherlands. Potential predictors for prolonged MV, defined as duration of ≥14 days, were considered using crosstabs. Selected predictors were analyzed using Cox regression analysis. On a total of 150 (27 %) patients requiring MV, 106 (71 %) patients needed prolonged MV. The median duration of MV was 28 days (Interquartile Range [IQR] 12–60 days). The strongest observed predictors of prolonged MV were muscle weakness and axonal degeneration or unexcitable nerves on nerve conduction studies. Patients who are unable to lift the arms from the bed (bilateral Medical Research Council [MRC] of deltoid muscles of 0–2) at 1 week after intubation have an 87 % chance to require prolonged MV versus 69 % in patients who are able to lift the arms from the bed (bilateral MRC of deltoid muscles of 3–10). Patients in this last group who had axonal degeneration or unexcitable nerves on nerve conduction studies also have a 90 % chance to require prolonged MV. Ventilated GBS patients who are unable to lift the arms from the bed and patients who have axonal degeneration or unexcitable nerves at 1 week are at high risk of prolonged MV, and tracheostomy should be considered in these patients.