Brighton diagnostic criteria for GBS can be found in Table 1.
High- dose intravenous immunoglobulin (IVIG) (2gr/kg) over 5 days and
heat therapy were started 24 hours after the hospitalization.
Nevertheless, limb ’ weakness got worse and severe respiratory failure
developed almost 11 days after admission. The patient was transferred to
the Intensive Care Unit (ICU) and required mechanical ventilation.
According to the clinical and arterial blood gases (ABG) parameters the
patient stared a cycle of non-invasive ventilation (NIV) with helmet
interface in assist pressure control ventilation (APCV) mode (PS 1O
mmHg, PEEP 7 mmHg, FiO2 60%) with good response.
She also stared intravenous continuous infusion of dexmedetomidine (0,8
γ/kg/h) with a Glasgow coma scale (GCS) 15 and a plasmapheresis cycles
of five sessions 48 hours after the hospitalization in the intensive
care unit. At the end of the plasmapheresis cycle, a new neurological
assessment revealed a mild improvement of the neurological system
After nine days, considering the clinical and hemodynamic stability (FC
58 bpm, SpO2 98%, PA 111/56 mmHg), the good respiratory mechanics and
the invariability of the neurological clinical picture the patient ended
the NIV cycle and a Venturi mask at FiO2 60% was applied. She also
started a plasmapheresis cycles of five sessions 48 hours after the
hospitalization in the intensive care unit.
At the end of the plasmapheresis cycle, a new neurological assessment
revealed a mild improvement of the neurological system. Therefore, the
patient was moved from the ICU to the Neurology department.
During the hospitalization, the patient started presenting problems of
psycho-motor agitation treated with the administration of antipsychotic
drugs such as an aliphatic phenothiazine neuroleptic. The hyposthenia of
the lower limbs raised and the patient started showing bilateral Bell’s
palsy. Simultaneously, a deterioration of respiratory function arised,
and the patient was treated once again with the application of oxygen
therapy (FiO2 50%).
A new plasmapheresis cycle was started but based on the results of the
emogas analysis (pH 7.45, pO2 51 mmHg, pCO2 30 mmHg) and considering the
vital signs (FC 120 bpm, SpO2 80%, PA 170/80 mmHg), the patient was
once again transferred to ICU where she started a new cycle of NIV with
helmet interface in pressure support ventilation (PSV) mode (PS 12
cmH2O; PEEP 10; FiO2 100%) and intravenous continuous infusion of
dexmedetomidine (0,6 γ/kg/h) considering the psychomotor agitation.
Almost 14 hours after admission in the Intensive Care Unit (ICU) the
control arterial blood gases (ABG) revealed a serious deterioration of
respiratory gas exchange. The patient was intubated and connected to the
Mechanical Artificial Ventilation (VAM).
One hour after intubation the electrocardiogram heart tracing revealed
ST segment depression, severe bradycardia (FC 20 bpm) with following
cardiac arrest. Cardiopulmonary resuscitation maneuvers with the use of
an automatic external defibrillator were performed according to Advanced
Cardiovascular Life Support (ACLS).
After 30 minutes there was no evidence of cardiac response so the
patient’s death was declared.