Cardiovascular autonomic dysfunction induced by mechanical insufflation‐exsufflation in Guillain–Barré syndrome

Mechanical insufflation‐exsufflation (MI‐E) is an effective airway clearance device for impaired cough associated with respiratory muscle weakness caused by neuromuscular disease. Its complications on the respiratory system, such as pneumothorax, are well‐recognized, but the association of the autonomic nervous system dysfunction with MI‐E has never been reported. We herein describe two cases of Guillain–Barré syndrome with cardiovascular autonomic dysfunction during MI‐E: a 22‐year‐old man who developed transient asystole and an 83‐year‐old man who presented with prominent fluctuation of blood pressure. These episodes occurred during the use of MI‐E with abnormal cardiac autonomic testing, such as heart rate variability in both patients. While Guillain–Barré syndrome itself may cause cardiac autonomic dysfunction, MI‐E possibly caused or enhanced the autonomic dysfunction by an alternation of thoracic cavity pressure. The possibility of MI‐E‐related cardiovascular complications should be recognized, and its appropriate monitoring and management are necessary, particularly when used for Guillain–Barré syndrome patients.