High-Dependency Care Without Mechanical Ventilation for Severe Guillain-Barré Syndrome in a Rural Low-Income Setting.

Guillain-Barré syndrome (GBS) is a major cause of neuromuscular respiratory failure globally. In many low-income settings, access to mechanical ventilation and disease-modifying therapy is limited. We describe the management of a young woman with rapidly progressive GBS and bulbar weakness in a mission hospital in northern Madagascar without access to intensive care facilities, invasive ventilation or immunotherapy. Respiratory failure was managed using a structured high-dependencyunit (HDU) framework combining noninvasive respiratory support with intensive nursing care, physiotherapy, regular repositioning and close nurse-led observation. The patient survived the acute phase, regained swallow and speech by Day 8 and was discharged from HDU on Day 15. At 1-year follow-up, she had recovered full upper limb strength with residual lower limb weakness. This case highlights the potential for structured supportive care in an HDU to sustain life in clinically significant neuromuscular respiratory failure when definitive critical care resources are unavailable.