A 31-year-old man with Guillain-Barre syndrome is being monitored on the ward. Vital capacity measured hourly falls progressively and reaches 14 mL/kg. He is awake and cooperative with oxygen saturation of 95% on room air. What is the most appropriate action?

• A Continue close monitoring and reassess when saturation drops below 90%
• B Give a trial of non-invasive ventilation and recheck vital capacity in 12 hours
• C Administer IVIG immediately and delay ventilatory decisions
• D Elective intubation and mechanical ventilation ✓

Explanation

In Guillain-Barre syndrome, elective intubation is advised when vital capacity falls below about 15 mL/kg, negative inspiratory force falls below 60 cm H2O, or a decline of more than 30% occurs, because respiratory arrest can be abrupt once fatigue sets in. Waiting for desaturation is dangerous since hypercapnia is a late sign. IVIG treats the disease process but does not replace airway protection at these thresholds.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.