Dados do Trabalho

Título

The evaluation of a second cycle of intravenous immunoglobulin for patients with Guillain-Barré syndrome on mechanical ventilation.

Resumo

Introduction: Approximately 25% of patients with Guillain-Barré syndrome (GBS) do not respond to the first cycle of intravenous immunoglobulin (IVIg) infusion and are offered a second cycle. There are a few studies on the effectiveness of this second infusion. Objectives: To evaluate the effectiveness of the second cycle of IVIg in individuals with GBS who required mechanical ventilation in the acute phase. Methods: We performed a retrospective review of the database of patients with GBS who required mechanical ventilation, between the years 1994 to 2018, aged > 6 years, with Brighton level 1 or 2 and who received 1 or 2 cycles of IVIg, in the state of Rio Grande do Norte. Demographic, clinical and outcome data up to 6 months were compared. Results: 74 individuals from a sample of 350 (21.4%) were selected. 59 (79.7%) received 1 cycle IVIg and 15 (20.3%) received 2 cycles IVIg. There was no difference between age (34 x 39 years; median; p=0.746) and sex (p=0.5501). There was also no difference between nadir (8 x 6 days; p=0.3979), facial paralysis (p=1,000), sensitive alterations (p=0.2207), presence of dysautonomia (p=0.1932), presence of anti-GM1 (p=1.000) and demyelinating and axonal electrophysiological subtypes (p=0.1241). The 1-cycle IVIg group had less diarrhea (p=0.0002) and more proximal weakness (p=0.0051). The 2-cycles IVIg group had more global weakness (p=0.0141) and tracheostomy (p=0.0077). The ability to walk at 6 months was similar (48X13 cases; p=1,000). However, the median time to walk was shorter in the 1-cycle IVIg group (31 x 90 days; p=0.0093), as was the time to gain 1 point on the Hughes disability scores (14 x 40, p=0.0004), the time on mechanical ventilation ( 13 x 34; p = 0.0001) and the days of hospitalization (43 x 59.5; p = 0.0014). Conclusion: This observational study did not observe better results after a second cycle of IVIg in GBS under mechanical ventilation. The absence of a history of diarrhea and the presence of proximal weakness were significantly present in the 1-cycle IVIg group, suggesting a good prognostic marker.

Palavras Chave

Guillain-Barré syndrome, intravenous immunoglobulin, immunotherapy, treatment

Área

Doenças Neuromusculares