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Guidelines for Neuroprognostication in Adults with Guillain–Barré Syndrome
BACKGROUND: Guillain–Barré syndrome (GBS) often carries a favorable prognosis. Of adult patients with GBS, 10–30% require mechanical ventilation during the acute phase of the disease. After the acute phase, the focus shifts to restoration of motor strength, ambulation, and neurological function, wit...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10241707/ https://www.ncbi.nlm.nih.gov/pubmed/36964442 http://dx.doi.org/10.1007/s12028-023-01707-3 |
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author | Busl, Katharina M. Fried, Herbert Muehlschlegel, Susanne Wartenberg, Katja E. Rajajee, Venkatakrishna Alexander, Sheila A. Creutzfeldt, Claire J. Fontaine, Gabriel V. Hocker, Sara E. Hwang, David Y. Kim, Keri S. Madzar, Dominik Mahanes, Dea Mainali, Shraddha Meixensberger, Juergen Sakowitz, Oliver W. Varelas, Panayiotis N. Westermaier, Thomas Weimar, Christian |
author_facet | Busl, Katharina M. Fried, Herbert Muehlschlegel, Susanne Wartenberg, Katja E. Rajajee, Venkatakrishna Alexander, Sheila A. Creutzfeldt, Claire J. Fontaine, Gabriel V. Hocker, Sara E. Hwang, David Y. Kim, Keri S. Madzar, Dominik Mahanes, Dea Mainali, Shraddha Meixensberger, Juergen Sakowitz, Oliver W. Varelas, Panayiotis N. Westermaier, Thomas Weimar, Christian |
author_sort | Busl, Katharina M. |
collection | PubMed |
description | BACKGROUND: Guillain–Barré syndrome (GBS) often carries a favorable prognosis. Of adult patients with GBS, 10–30% require mechanical ventilation during the acute phase of the disease. After the acute phase, the focus shifts to restoration of motor strength, ambulation, and neurological function, with variable speed and degree of recovery. The objective of these guidelines is to provide recommendations on the reliability of select clinical predictors that serve as the basis of neuroprognostication and provide guidance to clinicians counseling adult patients with GBS and/or their surrogates. METHODS: A narrative systematic review was completed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Candidate predictors, including clinical variables and prediction models, were selected based on clinical relevance and presence of appropriate body of evidence. The Population/Intervention/Comparator/Outcome/Time frame/Setting (PICOTS) question was framed as follows: “When counseling patients or surrogates of critically ill patients with Guillain–Barré syndrome, should [predictor, with time of assessment if appropriate] be considered a reliable predictor of [outcome, with time frame of assessment]?” Additional full-text screening criteria were used to exclude small and lower quality studies. Following construction of an evidence profile and summary of findings, recommendations were based on four GRADE criteria: quality of evidence, balance of desirable and undesirable consequences, values and preferences, and resource use. In addition, good practice recommendations addressed essential principles of neuroprognostication that could not be framed in PICOTS format. RESULTS: Eight candidate clinical variables and six prediction models were selected. A total of 45 articles met our eligibility criteria to guide recommendations. We recommend bulbar weakness (the degree of motor weakness at disease nadir) and the Erasmus GBS Respiratory Insufficiency Score as moderately reliable for prediction of the need for mechanical ventilation. The Erasmus GBS Outcome Score (EGOS) and modified EGOS were identified as moderately reliable predictors of independent ambulation at 3 months and beyond. Good practice recommendations include consideration of both acute and recovery phases of the disease during prognostication, discussion of the possible need for mechanical ventilation and enteral nutrition during counseling, and consideration of the complete clinical condition as opposed to a single variable during prognostication. CONCLUSIONS: These guidelines provide recommendations on the reliability of predictors of the need for mechanical ventilation, poor functional outcome, and independent ambulation following GBS in the context of counseling patients and/or surrogates and suggest broad principles of neuroprognostication. Few predictors were considered moderately reliable based on the available body of evidence, and higher quality data are needed. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12028-023-01707-3. |
format | Online Article Text |
id | pubmed-10241707 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-102417072023-06-07 Guidelines for Neuroprognostication in Adults with Guillain–Barré Syndrome Busl, Katharina M. Fried, Herbert Muehlschlegel, Susanne Wartenberg, Katja E. Rajajee, Venkatakrishna Alexander, Sheila A. Creutzfeldt, Claire J. Fontaine, Gabriel V. Hocker, Sara E. Hwang, David Y. Kim, Keri S. Madzar, Dominik Mahanes, Dea Mainali, Shraddha Meixensberger, Juergen Sakowitz, Oliver W. Varelas, Panayiotis N. Westermaier, Thomas Weimar, Christian Neurocrit Care NCS Guidelines BACKGROUND: Guillain–Barré syndrome (GBS) often carries a favorable prognosis. Of adult patients with GBS, 10–30% require mechanical ventilation during the acute phase of the disease. After the acute phase, the focus shifts to restoration of motor strength, ambulation, and neurological function, with variable speed and degree of recovery. The objective of these guidelines is to provide recommendations on the reliability of select clinical predictors that serve as the basis of neuroprognostication and provide guidance to clinicians counseling adult patients with GBS and/or their surrogates. METHODS: A narrative systematic review was completed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Candidate predictors, including clinical variables and prediction models, were selected based on clinical relevance and presence of appropriate body of evidence. The Population/Intervention/Comparator/Outcome/Time frame/Setting (PICOTS) question was framed as follows: “When counseling patients or surrogates of critically ill patients with Guillain–Barré syndrome, should [predictor, with time of assessment if appropriate] be considered a reliable predictor of [outcome, with time frame of assessment]?” Additional full-text screening criteria were used to exclude small and lower quality studies. Following construction of an evidence profile and summary of findings, recommendations were based on four GRADE criteria: quality of evidence, balance of desirable and undesirable consequences, values and preferences, and resource use. In addition, good practice recommendations addressed essential principles of neuroprognostication that could not be framed in PICOTS format. RESULTS: Eight candidate clinical variables and six prediction models were selected. A total of 45 articles met our eligibility criteria to guide recommendations. We recommend bulbar weakness (the degree of motor weakness at disease nadir) and the Erasmus GBS Respiratory Insufficiency Score as moderately reliable for prediction of the need for mechanical ventilation. The Erasmus GBS Outcome Score (EGOS) and modified EGOS were identified as moderately reliable predictors of independent ambulation at 3 months and beyond. Good practice recommendations include consideration of both acute and recovery phases of the disease during prognostication, discussion of the possible need for mechanical ventilation and enteral nutrition during counseling, and consideration of the complete clinical condition as opposed to a single variable during prognostication. CONCLUSIONS: These guidelines provide recommendations on the reliability of predictors of the need for mechanical ventilation, poor functional outcome, and independent ambulation following GBS in the context of counseling patients and/or surrogates and suggest broad principles of neuroprognostication. Few predictors were considered moderately reliable based on the available body of evidence, and higher quality data are needed. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12028-023-01707-3. Springer US 2023-03-25 2023 /pmc/articles/PMC10241707/ /pubmed/36964442 http://dx.doi.org/10.1007/s12028-023-01707-3 Text en © The Author(s) 2023, corrected publication 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | NCS Guidelines Busl, Katharina M. Fried, Herbert Muehlschlegel, Susanne Wartenberg, Katja E. Rajajee, Venkatakrishna Alexander, Sheila A. Creutzfeldt, Claire J. Fontaine, Gabriel V. Hocker, Sara E. Hwang, David Y. Kim, Keri S. Madzar, Dominik Mahanes, Dea Mainali, Shraddha Meixensberger, Juergen Sakowitz, Oliver W. Varelas, Panayiotis N. Westermaier, Thomas Weimar, Christian Guidelines for Neuroprognostication in Adults with Guillain–Barré Syndrome |
title | Guidelines for Neuroprognostication in Adults with Guillain–Barré Syndrome |
title_full | Guidelines for Neuroprognostication in Adults with Guillain–Barré Syndrome |
title_fullStr | Guidelines for Neuroprognostication in Adults with Guillain–Barré Syndrome |
title_full_unstemmed | Guidelines for Neuroprognostication in Adults with Guillain–Barré Syndrome |
title_short | Guidelines for Neuroprognostication in Adults with Guillain–Barré Syndrome |
title_sort | guidelines for neuroprognostication in adults with guillain–barré syndrome |
topic | NCS Guidelines |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10241707/ https://www.ncbi.nlm.nih.gov/pubmed/36964442 http://dx.doi.org/10.1007/s12028-023-01707-3 |
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