Guillain-Barré Syndrome Medical Slides

Present the "20/30/40 rule" for intubation: FVC <20 mL/kg, NIF worse than -30 cmH2O, or >30% decline in FVC from baseline. Emphasize that pulse oximetry is a late indicator of respiratory failure in neuromuscular disease — serial bedside FVC every 4-6 hours is the standard monitoring approach. Include the Erasmus GBS Respiratory Insufficiency Score (EGRIS) for predicting mechanical ventilation need at admission.

Show the equivalence data: the 1997 Plasma Exchange/Sandoglobulin GBS Trial demonstrated equal efficacy. IVIG (0.4 g/kg/day for 5 days) is generally preferred for ease of administration and availability. PLEX (200-250 mL/kg over 5 sessions) may be preferred in severe cases or when IVIG is contraindicated (IgA deficiency, renal failure). Emphasize that combining both treatments provides no additional benefit (Dutch GBS trial) and that corticosteroids alone are ineffective.

Present AIDP (most common in Western countries, demyelinating pattern on NCS with prolonged distal latencies and conduction block), AMAN (axonal, more common in Asia, associated with anti-GM1/GD1a antibodies and Campylobacter), and Miller Fisher (triad of ophthalmoplegia, ataxia, areflexia, with anti-GQ1b antibodies in >90%). Subtype identification guides prognosis — AMAN has faster recovery or worse outcome depending on axonal damage severity.