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Guillain-Barré Syndrome Treatment — FRCA Final MCQ

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ModerateIntensive Care MedicineGuillain-Barré Syndrome TreatmentFRCA Final

A 40-year-old man (80 kg) is intubated and ventilated on the ICU for Guillain-Barré syndrome. He has ascending weakness now affecting all four limbs (MRC grade 2/5) and respiratory muscles. His forced vital capacity is 0.8 L. What specific treatment has the strongest evidence for improving outcomes?

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Correct answer: A — IV immunoglobulin

Both IV immunoglobulin (IVIg) and plasma exchange have strong evidence for improving outcomes in Guillain-Barré syndrome, but IVIg is generally preferred due to ease of administration and similar efficacy. The standard dose is 0.4 g/kg/day for 5 days. Corticosteroids alone are NOT effective and should not be given. Treatment should be initiated within 2 weeks of symptom onset for maximum benefit. FVC <20 mL/kg or <1L is an indication for intubation and mechanical ventilation.

Reference: NICE – 2022 – Guillain-Barré syndrome management; ICS – 2023 – Neuromuscular weakness in ICU