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Çocuk Yoğun Bakım Ünitesinde Takip Edilen Guillain Barre Sendromu Olguları; 3 Yıllık Deneyim

Year 2021, , 231 - 237, 29.06.2021
https://doi.org/10.31832/smj.855110

Abstract

Amaç: Poliomiyelit eradike edildikten sonra akut flask paralizinin sğlıklı çocuklardaki en sık nedeni Guillain-Barre Sendromu (GBS) olmuştur. GBS, çocuk yoğun bakım (ÇYB) ünitesinde tedavi olmayı gerektiren nöromusküler hastalıklardan birisidir. Bu çalışmanın amacı, GBS tanısı ile ÇYB ünitesinde yatırılarak tedavi edilen hastalarla ilgili bir üniversite hastanesinin üç yıllık deneyimini sunmaktır.
Gereç ve Yöntemler: Mart 2016 ve Mart 2019 tarihleri arasında GBS tanısı ile ÇYB ünitesinde takip edilen hastalar retrospektif olarak değerlendirildi.
Bulgular: Çalışma süresi boyunca 22 hasta GBS tanısı aldı. Bu hastalardan 7 tanesinin ÇYB ünitesinde takip edilmesi gerekti. Bu 7 hastanın 8 yatışı çalışma grubunu oluşturdu. Dürt tanesi kız, 3 tanesi erkek idi. Yaşları 3 ile 12 yıl arasındaydı. Hastaların tümü solunum sıkıntısı semptomları ile ÇYB ünitesine yatırıldı. Hastalarda asendan paralizinin başlangıcından 3 ile 7 gün önce nonspesifik bir solunum yolu enfeksiyonu veya gastrointestinal enfeksiyon vardı. Tüm hastalara intravenöz immunoglobulin infüzyonu verildi. Beş hasta yatışında plazmaferez tedavisine ve mekanik ventilasyon desteğine ihtiyaç duyuldu. ÇYB ünitesinde yatış süresi 2 ile 87 gün ve hastanede yatış süresi 14 ile 98 gün idi. Hastaların hepsi taburcu edildi ve yardımsız yürüyebildi.
Sonuç: Sonuçlarımız, GBS tanılı hastalarda ÇYB takibinin çok önemli olduğunu gösterdi. Mekanik ventilatörde kalma süresi ve hastanede yatış süresi çok uzun olmasına rağmen, etkili bir ÇYB desteği ile bu hastalarda prognoz iyidir.

References

  • Jones HR Jr. Guillain-Barré syndrome: perspectives with infants and children. Semin Pediatr Neurol. 2000 Jun;7(2):91-102.
  • Chung A, Deimling M. Guillain-Barré Syndrome. Pediatr Rev. 2018 Jan;39(1):53-54.
  • Evans OB, Vedanarayanan V. Guillain-Barré syndrome. Pediatr Rev. 1997; 18:10.
  • Jones HR. Childhood Guillain-Barré syndrome: clinical presentation, diagnosis, and therapy. J Child Neurol. 1996; 11:4.
  • Korinthenberg R, Schessl J, Kirschner J. Clinical presentation and course of childhood Guillain-Barré syndrome: a prospective multicentre study. Neuropediatrics. 2007; 38:10.
  • Hund EF, Borel CO, Cornblath DR, Hanley DF, McKhann GM. Intensive management and treatment of severe Guillain-Barré syndrome. Crit Care Med. 1993; 21:433.
  • Harrar, D.B., Darras, B.T., Ghosh, P.S. Acute Neuromuscular Disorders in the Pediatric Intensive Care Unit. Journal of Child Neurology. 2020 35(1), pp. 17-24.
  • van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC, van Doorn PA. Guillain-Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol. (2014) 10:469–82.
  • Koul, R.L., Alfutaisi, A. Prospective study of children with Guillain-Barre syndrome. Indian J Pediatr. 75, 787 (2008).
  • Tang J, Dai Y, Li M, Cheng M, Hong S, Jiang L, et al. Guillain-Barré syndrome in Chinese children: a retrospective analysis. Pediatr Neurol. (2011) 45:233–7.
  • Bazaraa HM, Rady HI, Mohamed SA, Rabie WA, ElAnwar NH. Initial Response and Outcome of Critically Ill Children With Guillain Barre' Syndrome. Front Pediatr. 2019;7:378.
  • Sarnat HB. Gullian Barre Syndromme. In: Kliegman RM, Stanton BF, eds. Nelson’s Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier, 2016:3010-3013.
  • Dimachkie MM, Barohn RJ. Guillain-Barre Syndrome and Variants. Neurologic Clinics of NA. 2013; 31:491-510.
  • Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol. 1990;27(Suppl):21-4.
  • Hughes RA, Wijdicks EF, Barohn R, Benson E, Cornblath DR, Hahn AF, et al. Practice parameter: immunotherapy for Guillain-Barré syndrome: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2003; 61(6):736-40.
  • Patwa HS, Chaudhry V, Katzberg H, Rae-Grant AD, So YT. Evidence-based guideline: intravenous immunoglobulin in the treatment of neuromuscular disorders: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2012; 78(13):1009-15.
  • Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice –Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher. 2019;34: 171–354.
  • Kesici, S., Tanyıldız, M., Yetimakman, F., & Bayrakci, B. (2019). A Novel Treatment Strategy for Severe Guillain-Barré Syndrome: Zipper Method. Journal of Child Neurology, 34(5), 277–283.
  • El-Bayoumi MA, El-Refaey AM, Abdelkader AM, El-Assmy MM, Alwakeel AA, El-Tahan HM. Comparison of intravenous immunoglobulin and plasma exchange in treatment of mechanically ventilated children with Guillain Barré syndrome: a randomized study. Crit Care. 2011;15(4):R164.
  • Saad K, Mohamad IL, Abd El-Hamed MA, Tawfeek MS, Ahmed AE, Abdel Baseer KA, et al.A comparison between plasmapheresis and intravenous immunoglobulin in children with Guillain-Barré syndrome in Upper Egypt. Ther Adv Neurol Disord. 2016;9(1):3-8.
  • Mehta AB, Cooke CR, Wiener RS, Walkey AJ. Hospital Variation in Early Tracheostomy in the United States: A Population-Based Study. Crit Care Med. 2016; 44:1506.
  • Halawa EF, Ahmed D, Nada MAF. Guillain-Barré syndrome as a prominent cause of childhood acute flaccid paralysis in post polio eradication era in Egypt. Eur J Paediatr Neurol. (2011) 15:241–6.
  • Bhadoria P, Bhagwat AG. Severity Scoring Systems in Paediatric Intensive Care Units. Indian Journal of Anaesthesia. 2008;52:Suppl:663-675.

Guillain-Barre Syndrome Followed in the PICU; 3-year Experience

Year 2021, , 231 - 237, 29.06.2021
https://doi.org/10.31832/smj.855110

Abstract

Objective: After the poliomyelitis eradicated, Guillain-Barre Syndrome (GBS) is the most common cause of acute flaccid paralysis in healthy child. It is one of the neuromuscular disorders required treatment to pediatric intensive care unit. Aim of this study is to present the three-year’s experience of caring for patients with GBS admitted the PICU in the university hospital.
Materials and Methods: Patients who were admitted to the PICU with diagnosed GBS between March 2016 and March 2019 were evaluated retrospectively.
Results: Twenty-two patients were diagnosed with GBS during study period. Seven of them needed PICU in 8 admissions, and they formed the study group. Four of them were female and 3 of them were male. They were 3 to12 years old. All of them were admitted in the PICU because of respiratory distress symptoms. The paralysis followed a nonspecific respiratory or gastrointestinal infection by 3 to 7 days, and ascending progress was present. Intravenous immunoglobulin infusion was administered in all patients. Five of them need to plasmapheresis and mechanical ventilator support. Stay to PICU length was 2 to 87 days and hospitalization length was 14 to 98 days. All of them were discharged, and became able to walk unaided.
Conclusion: Our results show that PICU follow-up is very important in children with GBS. Although duration of mechanical ventilation, and hospitalization length is long, prognosis is good with effective management strategies.

References

  • Jones HR Jr. Guillain-Barré syndrome: perspectives with infants and children. Semin Pediatr Neurol. 2000 Jun;7(2):91-102.
  • Chung A, Deimling M. Guillain-Barré Syndrome. Pediatr Rev. 2018 Jan;39(1):53-54.
  • Evans OB, Vedanarayanan V. Guillain-Barré syndrome. Pediatr Rev. 1997; 18:10.
  • Jones HR. Childhood Guillain-Barré syndrome: clinical presentation, diagnosis, and therapy. J Child Neurol. 1996; 11:4.
  • Korinthenberg R, Schessl J, Kirschner J. Clinical presentation and course of childhood Guillain-Barré syndrome: a prospective multicentre study. Neuropediatrics. 2007; 38:10.
  • Hund EF, Borel CO, Cornblath DR, Hanley DF, McKhann GM. Intensive management and treatment of severe Guillain-Barré syndrome. Crit Care Med. 1993; 21:433.
  • Harrar, D.B., Darras, B.T., Ghosh, P.S. Acute Neuromuscular Disorders in the Pediatric Intensive Care Unit. Journal of Child Neurology. 2020 35(1), pp. 17-24.
  • van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC, van Doorn PA. Guillain-Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol. (2014) 10:469–82.
  • Koul, R.L., Alfutaisi, A. Prospective study of children with Guillain-Barre syndrome. Indian J Pediatr. 75, 787 (2008).
  • Tang J, Dai Y, Li M, Cheng M, Hong S, Jiang L, et al. Guillain-Barré syndrome in Chinese children: a retrospective analysis. Pediatr Neurol. (2011) 45:233–7.
  • Bazaraa HM, Rady HI, Mohamed SA, Rabie WA, ElAnwar NH. Initial Response and Outcome of Critically Ill Children With Guillain Barre' Syndrome. Front Pediatr. 2019;7:378.
  • Sarnat HB. Gullian Barre Syndromme. In: Kliegman RM, Stanton BF, eds. Nelson’s Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier, 2016:3010-3013.
  • Dimachkie MM, Barohn RJ. Guillain-Barre Syndrome and Variants. Neurologic Clinics of NA. 2013; 31:491-510.
  • Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol. 1990;27(Suppl):21-4.
  • Hughes RA, Wijdicks EF, Barohn R, Benson E, Cornblath DR, Hahn AF, et al. Practice parameter: immunotherapy for Guillain-Barré syndrome: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2003; 61(6):736-40.
  • Patwa HS, Chaudhry V, Katzberg H, Rae-Grant AD, So YT. Evidence-based guideline: intravenous immunoglobulin in the treatment of neuromuscular disorders: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2012; 78(13):1009-15.
  • Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice –Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher. 2019;34: 171–354.
  • Kesici, S., Tanyıldız, M., Yetimakman, F., & Bayrakci, B. (2019). A Novel Treatment Strategy for Severe Guillain-Barré Syndrome: Zipper Method. Journal of Child Neurology, 34(5), 277–283.
  • El-Bayoumi MA, El-Refaey AM, Abdelkader AM, El-Assmy MM, Alwakeel AA, El-Tahan HM. Comparison of intravenous immunoglobulin and plasma exchange in treatment of mechanically ventilated children with Guillain Barré syndrome: a randomized study. Crit Care. 2011;15(4):R164.
  • Saad K, Mohamad IL, Abd El-Hamed MA, Tawfeek MS, Ahmed AE, Abdel Baseer KA, et al.A comparison between plasmapheresis and intravenous immunoglobulin in children with Guillain-Barré syndrome in Upper Egypt. Ther Adv Neurol Disord. 2016;9(1):3-8.
  • Mehta AB, Cooke CR, Wiener RS, Walkey AJ. Hospital Variation in Early Tracheostomy in the United States: A Population-Based Study. Crit Care Med. 2016; 44:1506.
  • Halawa EF, Ahmed D, Nada MAF. Guillain-Barré syndrome as a prominent cause of childhood acute flaccid paralysis in post polio eradication era in Egypt. Eur J Paediatr Neurol. (2011) 15:241–6.
  • Bhadoria P, Bhagwat AG. Severity Scoring Systems in Paediatric Intensive Care Units. Indian Journal of Anaesthesia. 2008;52:Suppl:663-675.
There are 23 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Halil Keskin 0000-0003-4491-1327

Filiz Keskin 0000-0001-8166-5773

Ibrahim Basaslan This is me 0000-0002-5688-9641

Hüseyin Tan 0000-0003-3331-1828

Publication Date June 29, 2021
Submission Date January 6, 2021
Published in Issue Year 2021

Cite

AMA Keskin H, Keskin F, Basaslan I, Tan H. Guillain-Barre Syndrome Followed in the PICU; 3-year Experience. Sakarya Tıp Dergisi. June 2021;11(2):231-237. doi:10.31832/smj.855110

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