Guillain-Barré Syndrome

Admission

• Diagnosis and treatment of Guillain-Barré syndrome
• Admission to ICU, high-care, or general neurology ward (consider using EGRIS prognostic model)

Treatment indication

• Unable to walk unaided (Guillain-Barré syndrome disability score ≥3), especially when less than 2 weeks from onset of weakness?
• • Treatment indication with IVIg (0·4 g/kg daily for 5 days) or plasma exchange
• • Mildly affected patients (Guillain-Barré syndrome disability score 1-2): check for further deterioration or treatment indication

Treatment-related fluctuation (TRF)

• TRF after IVIg or plasma exchange?
• • Deterioration after initial stabilisation or improvement: re-treatment with IVIg (0·4 g/kg daily for 5 days or 1 g/kg for 2 days) or plasma exchange

Acute-onset CIDP

• Acute onset chronic inflammatory demyelinating polyneuropathy?
• • Three or more deteriorations (TRFs) or any deterioration after 8 weeks requires consideration of re-treatment with IVIg or with steroids (as for chronic inflammatory demyelinating polyneuropathy)

Improvement and discharge

• Further improvement?
• • Consider discharge to neurology ward, rehabilitation centre or home

Reconsider ICU admission

• At any stage, reconsider ICU admission (loop back to admission / treatment indication steps)

Monitoring (regularly check, initially every 1-3 h)

• • Respiration
• • Progression of weakness
• • Swallowing difficulties
• • Autonomic dysfunction
• • Pain

Complications

• • Venous thrombosis
• • Pressure ulcer
• • Pulmonary infections

Start or strongly consider

• • Physiotherapy
• • Rehabilitation
• • Speech therapy
• • Psychological help
• • Patient support group