Clinical predictors of intubation and prolonged ventilation in pediatric Guillain-Barré syndrome requiring intensive care: A retrospective observational study.

INTRODUCTION

Pediatric Guillain-Barré syndrome (GBS) may progress to respiratory failure requiring mechanical ventilation (MV), yet predictors of intubation, prolonged MV (PMV), and tracheostomy remain poorly defined. We aimed to identify factors associated with intubation and PMV and evaluate the impact of early versus late tracheostomy (>14 days) on outcomes.

METHODS

We retrospectively reviewed 75 children with GBS admitted to a Neuro-ICU (2008-2018). Demographic, clinical, electrophysiological, and cerebrospinal fluid data were collected. Outcomes included intubation, PMV (>21 days), tracheostomy, ICU and hospital length of stay, and disability scores. Predictors were analyzed using Firth's penalized logistic regression. Model performance was assessed using receiver operating characteristic (ROC) curves.

RESULTS

Of 75 children, 62 required intubation; 37 required PMV, and 31 underwent tracheostomy. On multivariable analysis, lower Medical Research Council (MRC) score at ICU admission independently predicted intubation (OR 0.91; p = 0.009) and PMV (OR 0.90; p = 0.036). Admission MRC score demonstrated fair discrimination for PMV (AUC 0.759), with a cutoff ≤11 yielding 62% sensitivity and 83% specificity. A model combining MRC at ICU Admission, female gender, GBS subtypes and absence of extraocular involvement demonstrated the best discriminative ability (AUC 0.891). PMV was associated with longer ICU and hospital stay (p < 0.001) and higher disability at discharge and follow-up. Outcomes did not differ between early and late tracheostomy.

CONCLUSION

Lower MRC score at ICU admission is a robust predictor of intubation and PMV in pediatric GBS. The association between absence of extraocular involvement and PMV should be considered with caution, as it was observed in a limited number of patients. Tracheostomy timing did not significantly influence outcomes.