Abstract
Background/Objectives An important component of evaluating patients with neuromuscular disorders such as Guillain-Barre Syndrome (GBS) is the detection of impending respiratory deterioration. Commonly used vital observations are insensitive. Communicating the importance of markers such as forced vital capacity (FVC) with non-neurology colleagues is necessary.
Methods In this case report, a patient is described with GBS who deteriorated while monitored and required emergent intubation.
Results A 71-year-old female presented to the emergency department with incoordination and shortness of breath of 16 hours of duration. The respiratory rate was 22 and oxygen saturations were 96% on 2L of oxygen. Ataxia and areflexia was evident however cranial nerve function, muscle power, and sensation were normal. A CT brain, angiogram, CTPA, MRI brain and spine were unrevealing. 5 hours after the presentation, the FVC was 1.36L, with unremarkable vital observations and ABG. This was communicated with ICU. Within 12 hours, the patient was found unresponsive with a respiratory rate of 15 and oxygen saturations of 98% on 3L. A repeat ABG indicated a pH of 6.98 and pCO2 of 97. The patient was emergently intubated and commenced on plasmapheresis empirically. The diagnosis of GBS was confirmed with NCS demonstrating an axonal sensorimotor polyneuropathy, and a stool NAT positive for Campylobacter.
Conclusion This case demonstrates that routine measures of respiratory function may be normal until late in the course of respiratory failure. The value of bedside spirometry for FVC is demonstrated and need for effective communication with non-neurology colleagues regarding this parameter highlighted.
