Guillian Barre Syndrome in ICU – Unique Patients, Special Challenges, for Nurses and All

OBJECTIVES: 1. To study the profile of patients with Guillian Barre Syndrome (GBS) admitted to our Neuro ICU over one year duration. MATERIALS AND METHODS: This is a retrospective observational study on patients with GBS admitted to our Neuro ICU, over a one year period from January 2024 to December 2024. We retrieved case records of eight patients admitted with GBS over one year. We collected demographic data, details of specific treatment such as plasmapheresis, IVIG, Rituximab etc. ICU interventions such as Intubation, mechanical ventilation, RRT, Vasopressor supports, tracheostomy and nutrition were recorded. We also recorded Pain, CAUTI, CLABSI, VAP, Pressure ulcer, Phlebitis and Sepsis events. We assessed patient and family's emotional and mental status subjectively. In December, the presenting author called all discharged patients over phone and documented the details. RESULTS: In 2024, nine patients with GBS were admitted to our ICU. 5 male and 4 female patients, Age range 20 to 62 years.(1,2) Four patients received IVIG, seven underwent plasmapheresis and two patients received Rituximab. Eight patients improved and got discharged, four each to Rehab and home. Average length of ICU stay was 12 days. 3 patients required invasive mechanical ventilation and one patient NIV. Two patients required tracheostomy and prolonged ventilatory support. We had one CAUTI and one VAP. Almost all patients were anxious and required reassurance during ICU stay. The patients on ventilator in particular were difficult to manage. We faced challenges with position change, pain, mobilization and nutrition. On December 10th 2024, we called all the survivors. 2 patients were able to get back to their job, six patients are still in rehabilitation. A 62 year old female was intubated and developed severe autonomic dysfunction during Plasmapheresis and had cardiac arrest. She could not be resuscitated. Every patient we cared for, had unique background, presentation and challenges. We needed a multidisciplinary approach. Nursing care was very labour and time intensive. But, when recovery was good, it was also very satisfying. CONCLUSION: GBS Patients are challenging to care for. One size does not fit all. Continuous quality care, emotional and social support is crucial. Support has to continue post ICU discharge to optimize Rehabilitation.