Question 27

A patient with newly diagnosed Guillain-Barré Syndrome (confirmed with LP and nerve conduction studies) has been referred to the ICU team for monitoring. They have requested admission to ICU for monitoring in case of deterioration.

a)    Outline the factors you would consider in the decision on whether to admit this patient to the ICU.
(70% marks)

b)    List the non-respiratory complications of severe Guillain-Barré Syndrome.    (30% marks)

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College answer

Not available.



Decision to admit a patient like this for monitoring is made on the basis of the interplay of numerous factors, as follows

  • Patient factors:
    • Frailty, i.e. physiological reserve, age, baseline function, and whether ICU admission and aggressive treatment are appropriate
    • History of chronic respiratory illness and other comorbidities
    • New acute respiratory complications, eg. hospital-acquired pneumonia
    • Clinical features suggesting worsening respiratory function, such as:
  • Disease factors:
    • Time course of progression: i.e. rapid deterioration over recent days or stable plateau
    • Type of disease, eg. "vanilla" GBS vs Miller-Fisher
    • Involvement of the autonomic nervous system (it can produce the sort of haemodynamic instability that could make the ward staff very nervous)
    • Whether appropriate treatment has been started, and how long ago
  • Environmental factors:
    • Evidence that the patient is not being monitored with sufficiently attentive diligence, eg. missing FVC data from previous days
    • Level of skill of ward staff where the patient remains
    • Monitoring capacity of the environment where the patient remains, eg. availability of continuous cardiac monitoring or oximetry
    • Capacity of the ICU or hospital to care for the patient with GBS (eg. availability of immunoglobulin or plasmapheresis  in a small regional hospital)


Nonrespiratory complications of GBS include those directly related to GBS and those which are associated with the overall picture of prolonged immobility and long-term ICU stay:

  • Airway complications
    • Poor cough and dysphonia (cranial nerve involvement)
    • Complications related to prolonged intubation or tracheostomy
  • Circulatory complications:
    • Haemodynamic instability and dysautonomia due to autonomic involvement
  • Neurological:
    • Paraesthesia
    • Pain from motionlessness
    • Psychological consequences of prolonged hospital stay 
  • Gastrointestinal:
    • Ileus and constipation
    • Malnutrition due to swallowing dysfunction
  • Haematological:
    • Increased risk of DVT and VTE
  • Infectious complications:
    • Increased predisposition to infection due to multiple indewlling devices, immunosuppressant therapy and prolonged hospital stay
    • Hospital-acquired pneumonia
    • Sinusitis due to long term NGT requirement
    • UTI due to long term IDC requirement
    • Cross-contamination with MROs


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van Leeuwen, Nikki, et al. "Hospital admissions, transfers and costs of Guillain-Barré syndrome." PloS one 11.2 (2016): e0143837.

Lawn, Nicholas D., et al. "Anticipating mechanical ventilation in Guillain-Barré syndrome." Archives of neurology 58.6 (2001): 893-898.

Barnes, Stephanie L., and Geoffrey K. Herkes. "Guillain–Barré syndrome: clinical features, treatment choices and outcomes in an Australian cohort." Internal medicine journal 50.12 (2020): 1500-1504.

Shahrizaila, Nortina, Helmar C. Lehmann, and Satoshi Kuwabara. "Guillain-Barré syndrome." The Lancet (2021).

van den Berg, Bianca, et al. "Guillain-Barre syndrome: pathogenesis, diagnosis, treatment and prognosis." Nature Reviews Neurology 10.8 (2014): 469-482.

Yuki, Nobuhiro, and Hans-Peter Hartung. "Guillain–Barré syndrome." New England Journal of Medicine 366.24 (2012): 2294-2304.