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Guillain-Barré Syndrome – Respiratory Failure — SCE Neurology MCQ

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ModeratePeripheral Neuropathy & NeuromuscularGuillain-Barré Syndrome – Respiratory FailureSCE Neurology

A 45-year-old man with GBS has an FVC of 1.2 L (predicted 4.5 L, 27% predicted) and is struggling to clear secretions. What is the most appropriate immediate management?

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Correct answer: A — Elective intubation and mechanical ventilation

An FVC <20 mL/kg (or approximately <30% predicted) is a critical threshold for considering elective intubation in GBS (the "20/30/40 rule": FVC <20 mL/kg, MIP >−30 cmH₂O, MEP <40 cmH₂O). This patient's FVC at 27% predicted indicates impending respiratory failure requiring intubation. A: NIV is not recommended in neuromuscular respiratory failure with this degree of compromise. C: Dose escalation of IVIg is not standard practice. D: Aminophylline has no role. E: Plasma exchange is a treatment option but the immediate priority is airway management.

Reference: ABN GBS Guidelines; EAN/PNS GBS Guidelines (2023)