Síndrome de Guillain Barré: perfil clínico epidemiológico y asistencia de enfermería / Síndrome de Guillain Barré: perfil clínico epidemiológico e assistência de enfermagem / Guillain Barré syndrome: epidemiological clinical profile and nursing care

INTRODUCCIÓN: El Síndrome de Guillain-Barré (SGB) se considera una polineuropatía inflamatoria aguda. OBJETIVO: Conocer las características sociodemográficas, clínicas epidemiológicas y asistenciales de pacientes internados con SGB en un hospital escolar del Oeste de Paraná. METODOLOGÍA: Se trata de una investigación cuantitativa, retrospectiva acerca de la caracterización sociodemográfica, clínica epidemiológica y asistencial de pacientes internados con SGB en un hospital escolar en el período de 2013 a 2017. Totalizando 23 pacientes cuyos prontuarios electrónicos fueron analizados.Todos los análisis estadísticos se realizaron en el programa XLStat (2010). RESULTADOS: La mayoría de los pacientes presentó edades entre 51 y 60 años (31,12%), seguidas de las edades de 41 a 50 años (13,04%) y menores de 15 años (13,04%), sexo masculino (60, 87), con gran parte presentando síntomas infecciosos previos como mialgia, cefalea, fiebre, diarrea. Los síntomas referentes a SGB presentados en el período de 4 a 9 días antes de la internación englobó la forma ascendente, simétrica, con disminución de la fuerza muscular. Durante la internación fueron sometidos a procedimientos como cateterismo vesical y punción venosa periférica. Entre los exámenes de laboratorio se destacó el hemograma y diagnóstico a la electroneuromiografía. El tratamiento principal fue la inmunoglobulina. La mayoría de los pacientes presentó alta dependencia de asistencia de enfermería conforme sistema de clasificación de pacientes de Fugulin. CONCLUSIÓN: El desarrollo de estudios que propician el conocimiento de la caracterización de un grupo específico de pacientes atacados por una enfermedad considerada rara, se constituyen en instrumentos para la planificación en salud

INTRODUÇÃO: A Síndrome de Guillain-Barré (SGB) é considerada uma polineuropatia inflamatória aguda. OBJETIVO: Conhecer as características sócio demográficas, clínica epidemiológicas e assistenciais de pacientes internados com SGB em um hospital escola do Oeste do Paraná. METODOLOGIA: Trata-se de uma pesquisa quantitativa, retrospectiva acerca da caracterização sócio demográfica, clínica epidemiológica e assistencial de pacientes internados com SGB em um hospital escola no período de 2013 a 2017. Totalizando 23 pacientes cujos prontuários eletrônicos foram analisados. Todas as análises estatísticas foram realizadas no programa XLStat (2010). RESULTADOS: A maioria dos pacientes apresentou idades entre 51 e 60 anos (31,12%), seguidas das idades 41 a 50 anos (13,04%) e menores de 15 anos (13,04%), sexo masculino (60,87), com grande parte apresentando sintomas infecciosos prévios como mialgia, cefaleia, febre, diarreia. Os sintomas referentes a SGB apresentados no período de 4 a 9 dias antes da internação englobou a forma ascendente, simétrica, com diminuição da força muscular. Durante a internação foram submetidos a procedimentos como cateterismo vesical e punção venosa periférica. Entre os exames laboratoriais destacou-se o hemograma e diagnóstico a eletroneuromiografia. O tratamento principal foi a imunoglobulina. A maioria dos pacientes apresentou alta dependência para assistência de enfermagem conforme sistema de classificação de pacientes de Fugulin. CONCLUSÃO: O desenvolvimento de estudos que propiciam o conhecimento da caracterização de um grupo específico de pacientes acometidos por uma doença considerada rara, constituem-se em instrumentos para o planejamento em saúde

INTRODUCTION: Guillain-Barré syndrome (GBS) is considered an acute inflammatory polyneuropathy. OBJECTIVE: To know the socio-demographic, clinical epidemiological and care characteristics of patients hospitalized with GBS in a school hospital in the West of Paraná. METHODOLOGY: This is a quantitative, retrospective study about the socio-demographic characterization, clinical epidemiology and care of hospitalized patients with GBS in a school hospital from 2013 to 2017. Totaling 23 patients whose electronic records were analyzed. All statistical analyzes were performed in the XLStat program (2010). RESULTS: The majority of the patients presented ages ranging from 51 to 60 years (31.12%), followed by ages 41 to 50 (13.04%) and under 15 (13.04%), male (60.87) , with most presenting previous infectious symptoms such as myalgia, headache, fever, diarrhea. The symptoms related to GBS presented in the period from four to nine days before admission included the ascending, symmetrical form with a decrease in muscle strength. During the hospitalization they underwent procedures such as bladder catheterization and peripheral venous puncture. Among the laboratory exams, the blood test and diagnosis of electro-urography were highlighted. The main treatment was immunoglobulin. Most of the patients presented high dependence for nursing care according to Fugulin's patient classification system. CONCLUSION: The development of studies that allow the knowledge of the characterization of a specific group of patients affected by a disease considered rare, constitute instruments for health planning

Guillain-Barré syndrome.

Individuals with Guillain-Barré syndrome (GBS) have sudden-onset polyneuropathy. This is characterised by muscle weakness, which occurs because of damage to the peripheral nervous system.

Clinico-electrophysiological profile and predictors of functional outcome in Guillain-Barre syndrome (GBS).

INTRODUCTION: Guillain-Barre syndrome (GBS) is an acute polyradiculoneuropathy with varied severity of presentation. AIMS: To study the clinical and electrophysiological profile of patients with GBS and to determine the factors associated with poor functional outcome and need for mechanical ventilation. SETTINGS AND DESIGN: It was a hospital-based prospective observational study. METHODS AND MATERIAL: 90 patients with GBS diagnosed as per Asbury and Cornblath criteria were enrolled and followed up for 6 months. Various epidemiological, clinical and electrophysiological parameters were evaluated. Hughes motor scale was used to measure functional outcome. Factors associated with poor functional outcome and need for mechanical ventilation were determined. RESULTS: 90 patients (56 males; 34 females; mean age of 29.3±15.2 years) were enrolled in this study. Amongst these 6 (6.7%) patients died during in-hospital stay. Antecedent infection was present in 29 (32.2%), autonomic dysfunction in 31 (34.4%), bulbar palsy in 21 (23.3%), neck flexor weakness in 52 (57.8%). 60 cases (66.7%) were of axonal variety and 30 (33.3%) of demyelinating variety. On univariate analysis, predictors associated with poor functional outcome at 6 months were autonomic dysfunction (p=0.013), neck flexor weakness (p=0.009), requirement of ventilatory assistance (p=<0.001), MRC sum score<30 on admission (p=<0.001) and axonal pattern on electrophysiological assessment (p=<0.001). On multivariate analysis, MRC sum score<30 on admission (p=0.007) and axonal pattern on electrophysiological assessment (p=<0.001) were independently associated with poor functional outcome at 6 months. Factors associated with need for mechanical ventilation were presence of autonomic dysfunction (p=<0.001), cranial nerve palsy including facial palsy (p=<0.001) and bulbar palsy (p=0.002), neck flexor weakness (p=<0.001), low MRC sum score (<30) (p=0.001), and low proximal CPN CMAP amplitude to distal CPN CMAP amplitude ratio (p=0.042); none of them being significant on multivariate analysis. CONCLUSIONS: Detailed evaluation of the clinical and electrophysiological profile may help in predicting the functional outcome and need for mechanical ventilation in patients with GBS.

Guillain-Barre syndrome: management and treatment options for patients with moderate to severe progression.

Guillain-Barre syndrome (GBS) is a syndrome that affects the immune system and attacks the peripheral nervous system. Discussion includes defining GBS as well as its etiology and differential diagnosis. Patients with GBS are not uncommon, and therefore it is important to be educated and to have a more precise understanding. GBS patients need to be treated holistically through emotional and physical support and known effective treatments. Through this article, readers will be able to achieve a thorough understanding of GBS and management options/strategies. Clinical features and manifestation of presenting symptoms will assist in determining initial laboratory studies, imaging, and any other testing that should be performed. Proper and quick diagnosis of GBS will be critical to further optimize treatment options and to decrease the likelihood of further immediate progression. Treatment modalities will be discussed as well as management during the acute hospital course and after discharge from the acute care facility. Discussion will focus on moderate to severe cases and associating treatment plans evaluated from evidence-based practice.

Economic cost of Guillain-Barré syndrome in the United States.

OBJECTIVE: This study estimated the annual economic cost of Guillain-Barré syndrome (GBS) in the United States in 2004, including the direct costs of medical care and the indirect costs due to lost productivity and premature death. METHODS: The cost-of-illness method was used to determine the costs of medical care and lost productivity, and a modified value of a statistical life approach was used to determine the cost of premature deaths. Data were obtained from the Nationwide Inpatient Sample, the Medical Expenditure Panel Survey, the Compressed Mortality File, a telephone survey of 180 adult patients with GBS, and other sources. RESULTS: The estimated annual cost of GBS was $1.7 billion (95% CI, $1.6 to 1.9 billion), including $0.2 billion (14%) in direct medical costs and $1.5 billion (86%) in indirect costs. Most of the medical costs were for community hospital admissions. Most of the indirect costs were due to premature deaths. The mean cost per patient with GBS was $318,966 (95% CI, $278,378 to 359,554). CONCLUSIONS: The economic cost of Guillain-Barré syndrome (GBS) was substantial, and largely due to disability and death. The cost estimate summarizes the lifetime health burden due to GBS in monetary terms, and provides some of the information needed to assess the cost-effectiveness of health measures that affect GBS.

The morbidity and outcome of patients with Guillain-Barré syndrome admitted to the intensive care unit.

UNLABELLED: One third of patients with Guillain-Barré syndrome (GBS) require admission to the intensive care unit (ICU), associated with significant risk of morbidity, mortality, and incomplete recovery. METHODS: 76 adult patients with GBS admitted to the ICU at a regional referral center over a 20-year period were studied. We determined the frequency, nature, and predictors of complications they experienced while in the ICU; this morbidity was related to long-term functional recovery and time to regain independent ambulation, extracted from longitudinal follow-up data. RESULTS: ICU stay was a median 21 days and mechanical ventilation (MV) was required in 78% (median duration 28 days). Two-thirds suffered at least one major complication, most commonly pneumonia (54%). Morbidity was strongly associated with MV and male sex. Mortality occurred in only 5 patients (6.5%). Over an average 3 years follow-up, recovery of independent ambulation was seen in 75%, with advanced age being the most powerful predictor of poor outcome. Prolonged MV and severe axonal loss did not preclude a favorable recovery. Time to ambulate was a median 198 days, although recovery could occur as late as ten years after onset; slower recovery was associated with ICU complications, prolonged MV, and early axonal abnormalities. CONCLUSION: Although patients with GBS suffer significant morbidity during protracted ICU stays, with meticulous supportive care, many make gratifying functional recoveries. In severely afflicted patients, this may only be appreciated after extended follow-up.

The effects of Guillain-Barré syndrome on the close relatives of patients during the first year.

OBJECTIVE: To study the impact of Guillain-Barré Syndrome (GBS) on the psychosocial functioning of the closest relative and on family functioning during the first year after GBS. METHOD: At 1 (=T1), 3 (=T3), 6 (=T6), and 12 months (=T12) after the onset of GBS, relatives of patients received the General Health Questionnaire (GHQ28) and the Family Assessment Device (FAD). Sixty-three relatives returned the GHQ28 at all four designated intervals. At T1 the relatives also received a questionnaire that contained questions on the impact on their daily life. The answers to these questions yielded a Daily Living Impact index. From the 110 relatives, 86 returned this questionnaire. RESULTS: 72% of the 86 relatives reported one or more problems in daily living. At T1 the scores of the GHQ subscales ranged from normal to mildly disturbed. The relatives showed significant improvement in their somatic complaints and anxiety during the first half year. Social dysfunction remained somewhat less than normal, severe depression was not found. At T1 and T3 the scores of the GHQ28 and some subscales differed significantly depending on the severity of the functional status of the patient, but not at T6 and T12. Relatives of patients with severe residua at 1 month score worse on the GHQ28 and most subscales at 6 months. The FAD was normal at all moments measured. CONCLUSIONS: Psychological morbidity of close relatives is significantly higher in the first months after the onset of GBS. The patient's condition has an important impact on the psychosocial functioning of close relatives. Therefore, a family approach is recommended to neurologist and other medical personnel during the first period of the disease. Also patient support groups may play a beneficial role for the relatives of GBS patients.

Two decades have passed ... and still it is her eyes that I remember: reflections of a pediatric nurse.

A pediatric nurse reflects on her practice by recounting her experience while caring for a child with Guillian Barre 20 years ago. Principles and lessons relevant to guide pediatric nursing practice in today's health care environment are identified.

Understanding Guillain-Barré syndrome and central nervous system involvement.

Guillain-Barré syndrome is a rare neurological disease that causes paralysis and may necessitate hospitalization for some patients in its acute stages. It primarily affects the peripheral nervous system, though recent research has shown that for some patients, the central nervous system is involved. The acute phase often requires intensive care services. Recognition is growing that recovery is not as smooth and free of symptoms as previously thought. Following "recovery" some people endure long-term residual symptoms, such as fatigue and pain. Nursing input can be of value by providing support, information, explanations, and empathy to reassure patients and families. A greater understanding of the nature and course of the disease and its ramifications can lead to more effective nursing management and a faster rehabilitation process.

Supportive care for patients with Guillain-Barré syndrome.

A multidisciplinary consensus group searched MEDLINE from 1966 to May 2003, extracted relevant references, and prepared recommendations on supportive care for Guillain-Barré syndrome. In the absence of randomized controlled trials, we agreed on recommendations by consensus based on observational studies and expert opinion. In the acute phase in bed-bound adult patients, the group recommended the use of heparin and graduated pressure stockings to prevent deep vein thrombosis, monitoring for blood pressure, pulse, autonomic disturbances, and respiratory failure, and the timely institution of artificial ventilation and tracheostomy. Pain management is difficult, but carbamazepine or gabapentin may help. The cautious use of narcotic analgesics may be needed. Disabled patients should be treated by a multidisciplinary rehabilitation team and should receive an assistive exercise program. Persistent fatigue following Guillain-Barré syndrome is common and may be helped by an exercise program. Because of a very small and possibly only theoretical increase in the risk of recurrence following immunization, the need for immunization should be reviewed on an individual basis. More research is needed to identify optimal methods for all aspects of supportive care.

The ventilated patient undergoing hydrotherapy: a case study.

The ascending peripheral neuropathy and paralysis that result from Guillain-Barre Syndrome's (GBS) demyelination of peripheral nerves is a challenge to health professionals; the patient requires support during the acute disease process and during the remyelination recovery period, often lasting months to years. The staff of a major metropolitan teaching hospital's critical care unit (CCU) and physiotherapy departments developed a hydrotherapy treatment programme for a ventilated patient with GBS. Through careful planning and appropriate preparation, it was found that hydrotherapy could successfully and safely be incorporated into a patient's treatment regimen. The benefits included improved range of movement due to the supportive nature of water, anecdotal increased strength, size and movement of remyelinating muscles and a psychological improvement. Although this patient has not recovered from GBS to be independent, hydrotherapy was a valuable part of the treatment regimen and it could be suggested the increase muscle strength lead to improved respiratory function and enabled weaning from ventilation, reducing intensive care length of stay and cost.

Guillain-Barré en un enfermo trasplantado / No disponible

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