Dados do Trabalho

Título

EVALUATE, IDENTIFY, INTERVENE: PRACTICAL REFLECTIONS FOR THE IMPROVEMENT OF HEALTH INDICATORS IN THE TREATMENT OF GUILLAIN-BARRÉ SYNDROME.

Resumo

Introduction. Guillain-Barré syndrome (GBS) affects about 100,000 new patients worldwide every year. Mortality from this disease can range from 3 to 10%, depending, in terms of modifiable factors, on access to adequate health care, which can be problematic in low income regions. Objetive. To determine the mortality rate, clinical complications profile, length of hospital stay, time to initiation of pharmacological treatment and presence of side effects in Barbacena´s health care region (251630 population). Results. 33 patients were included in the analysis. The mortality rate due to GBS was 6%. The rate of clinical complications during hospital stay was 48,5% (n=16), mainly infection/sepsis (n=8, 24,2%), cardiac arrhythmias (n=5, 15,2%), intestinal constipation (n=5, 15,2%) and decubitus ulcers (n=3, 9,1%). All patients with GBS were treated with immunoglobulin (IgIV). About 78,8% (n=26) started IgIV within 2 weeks of symptom onset, and 21,2% (n=7) between 2 and 4 weeks of disease presentation. There was no treatment-related fluctuation and no need for retreatment with IgIV in any patient. Only 6,1% (n=2) of patients had IgIV side effects, both of then had headache and one of then had also diaphoresis and sinusal tachycardia. No patient was treated with plasmapheresis. Most patients were hospitalized for up to 2 weeks (45,5%). A small proportion (12,1%) was hospitalized for more than 30 days. Conclusion. Although the length of hospital stay was considered adequate in most cases (up to 2 weeks) and access to first-line treatment (IgIV) was excellent, the rate of clinical complications during hospital stay was high, specially infections/sepsis and arrhythmias, wich points to the need of protocols for better prevention of nosocomial infection, frequent evaluation of the swallowing capacity to avoid bronchoaspiration pneumonia, rotation of decubitus to avoid ulcers, routine cardiac monitoring and prompt treatment of dysautonomic complications. Non-ischemic chest pain due to IgIV would be an uncommom side effect (0,1-0,9%) of the medication, according to manufacturer. But in this study sample, this symptom was present in 6,1% of patients. The authors had a good experience in the treatment of this side effect by reduction of IgIV flow to a minimum of 0,5ml/kg/hour.