A 40-year-old man with Guillain-Barre syndrome is being monitored. Vital capacity falls progressively from 55 mL/kg to 13 mL/kg over 24 hours and he cannot count to 20 in one breath. What is the appropriate management decision?

• A Continue close observation and repeat spirometry every 24 hours
• B Start non-invasive positive pressure ventilation alone
• C Elective intubation and mechanical ventilation ✓
• D Administer a further course of IVIg immediately before deciding on ventilation

Explanation

In GBS, elective intubation is advised when vital capacity falls below about 15 mL/kg, negative inspiratory force exceeds minus 30 cm H2O, or there is rapid decline, bulbar dysfunction, or autonomic instability. Waiting until frank respiratory failure raises complication rates. Non-invasive ventilation is generally inadequate because bulbar weakness and secretions predominate. Immunotherapy should already be running and does not substitute for airway protection.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.