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Children with GuillianBarre: IVIG vs Plasma Exchange FERRIS STATE UNIVERSITY NURS 440 COURTNEY LIST Introduction Best treatment option for children with Guillain-Barre Syndrome [GBS] on mechanical vent IVIG vs Plasma Exchange Indicators to define best treatment Decreased time on Mechanical Ventilation Decreased length of PICU stay Ambulatory function regained About Guillain-Barre Guillain-Barre Syndrome (GBS) Leading cause of acute flaccid paralysis Polyneuropathy involving mainly motor dysfunction, sometimes sensory Rapidly progressing muscle weakness with absent deep tendon reflexes GBS follows various viral infections, bacterial infections or vaccines Autoimmune response- molecular mimcry Symptoms Paralysis ascends starting in the lower limbs moving to the trunk then upper limbs and possibly respiratory depression Descending regain function starting in the trunk moving toward lower limbs Labile blood pressure, hypotension or bradycardia (Autonomic dysfunction) Increase in CSF Protein >45 mg/dL Treatment/Complications Treatment- Decrease circulating antibodies IVIG Plasma Exchange/Plasmapheresis Intravenous immunoglobulin- neutralizes harmful antibodies Plasma is removed from body, antibodies are removed, plasma is replaced Complication of GBS Paralysis Respiratory distress- Mechanical ventilation Important to get patient off vent as fast as possible Evidence for Care Nursing Theory Orlando’s Nursing Process Theory Find out the immediate need Directly or indirectly provide help Prevents inaccurate diagnosis or ineffective plans Guillian-Barre patients can have rapid changes in physical state Important to implement Orlando’s theory to meet patient needs Evaluation of Evidence Method Population: Children with GBS on a vent 20 Random GBS children received IVIG/ 21 received Plasma exchange Randomization done using computer Specific guidelines were set when to wean off vent Outcome Measures evaluated Duration of mechanical ventilation, Length of PICU stay and ability to walk unaided within 4 weeks of PICU discharge Evaluation of Evidence Results No significant complications in either group- both treatments safe PE group- Weaned off vent faster, shorter PICU stay and more children could walk Slightly shorter- ~2 days Credibility/Limitations Credibility Peer Reviewed Level of evidence Level 1- Randomized Controlled Limitations Takes place in Egypt Unknown what other medications were given Were they comparable between groups? Did they contribute to faster healing times? Patient Care Design Collaboration Physician and other members Treatment- Pros/Cons- Risks/Benefits Nurse Leader Evidence Based Practice Continue educating oneself on best treatment for patients with GBS Patient Care Design Plan of Care Nursing Diagnosis: Patient outcome Ineffective breathing pattern r/t respiratory muscle weakness or paralysis Patient will report ability to breath comfortably prior to transfer to general medical floor Interventions Assess respiratory status and function every 2 hours Assess if patient is able to spontaneously take their own breath every 2 hours Advocate Role Empathy Outcomes Fine line- optimism and realistic Encouraging Advocate Other disciplines/families Care intensive References El-Bayoumi, M. A., El-Refaey, A. M., Abdelkader, A. M., El-Assmy, M. M., Alwakeel, A. A., & El-Tahan, H. M. (2011). Comparison of intravenous immunoglobulin and plasma exchange in treatment of mechanically ventilated children with guillain-barre syndrome: a randomized study. Critical Care, 15:R164. doi:10.1186/cc10305 Faust C. .Orlando's deliberative nursing process theory: a practice application in an extended care facility. J Gerontol Nurs. 2002 Jul;28(7):14-8
