THE Guillain-Barré syndrome (GBS) is a paralytic polyneuropathy of unknown etiology that may occur in epidemic proportions, as experienced in association with swine flu vaccine. Even without the higher rate of GBS associated with influenza vaccines, hundreds of cases of GBS usually occur each year, with 20% to 25% requiring respiratory assistance. Since there is no definitive treatment of GBS, supportive measures are necessary until spontaneous recovery.
In severe cases involving respiratory paralysis, tracheostomy and mechanical ventilation have apparently been the standard treatment.1-3 In three patients admitted to the Children's Hospital Medical Center, Boston, respiratory insufficiency developed secondary to GBS. These patients were ventilated by nasal endotracheal intubation rather than tracheostomy for up to two weeks. This experience indicates that the higher incidence of complications with tracheostomies may be avoided in the treatment of patients with respiratory difficulty secondary to GBS.
Report of Cases
A 10-year-old, 25-kg