To the Editor.—
The CLINICAL NOTE by Newsum et al (1979;242:1650) speaks against tracheostomy in cases of Guillain-Barré syndrome (GBS) in need of assisted ventilation. Translaryngeal intubation is offered as a safe alternative for two weeks only, after which tracheostomy is suggested.We would like to present a case of GBS with respiratory failure illustrating that nasotracheal intubation could be used for a longer period.
Report of a Case.—
A 5-year-old girl weighing 16 kg was admitted with a two-day history of increased weakness of the legs, bilateral palpebral ptosis, and slurring speech. Over the next 24 hours her condition deteriorated, and cranial as well as somatic nerves were involved. Respiratory muscle and bulbar paralysis made a nasotracheal intubation with a 5.0-mm uncuffed tube and mechanical ventilation necessary. Her maximum inspiratory and expiratory pressures were low.1 This condition continued for 30 days, and gradually the girl was weaned from