Treatment Options

Monitoring

• Lung function initially every four hours
• ECG
• BP
• Autonomic function – pupils and ileus
• Check for swallowing dysfunction

General measures

• Pain relief: try to avoid opioids
• Chronic neuropathic pain: amitriptyline or antiepileptic drugs
• DVT prophylaxis
• Eye care
• Meticulous nursing to avoid pressure sores
• Physiotherapy to avoid contractures
• Consider early ICU admission for severely affected patients

Specific treatments

• IVIG or PE for those unable to walk, ideally to start within two weeks of onset of symptoms
• Typical IVIG regimen: 0.4g/kg for five days
• Typical PE regimen: total exchange of five plasma volumes in two weeks
• Retreatment with IVIG may be indicated if there is a secondary deterioration

Indications for ICU admission

• Risk of aspiration pneumonia
• Requiring ventilated support
• Rapidly-progressive disease
• Labile heart rate or blood pressure

The Erasmus GBS Respiratory Insufficiency Score (EGRIS) is a validated risk prediction tool to predict the probability of respiratory insufficiency within the first week of admission. An EGRIS score of 5–7 suggests 65% (54–76%) probability of respiratory insufficiency in the first week of admission.^7,8

A modified EGRIS (mEGRIS) is a simplified version that can be used up to a month after onset of symptoms (this has not been externally validated).

The 20/30/40 rule to anticipate the need for mechanical ventilation has also been used with some success^7,8:

• vital capacity <20 ml kg⁻¹,
• maximal inspiratory pressure <30 cmH₂O
• maximum expiratory pressure <40 cmH₂O

The management of GBS in summary is as follows⁸: