Plasma exchange aids respiratory recovery in pediatric GBS
MedWire News: For children with respiratory failure associated with Guillain Barre syndrome (GBS), plasma exchange (PE) may reduce the time spent on mechanical ventilation (MV) compared with intravenous immunoglobulin (IVIG), research suggests.
This finding differs from trial results for adults which found similar efficacy for the two treatments, report Mohammed El-Bayoumi and colleagues, from Mansoura University Children Hospital in Egypt.
The team randomly assigned 41 children who required endotracheal MV within 14 days of GBS onset to receive a 5-day course of IVIG (0.4 g/kg per day, n=20) or a 5-day course of one volume PE (n=21).
The children were aged 49-143 months old and 18 patients in each treatment arm underwent lumbar puncture. The patient groups were similar in terms of age, weight, duration of illness before MV, diarrhea, cranial nerve involvement, muscle power, and significant elevation of cerebrospinal fluid (CSF) protein levels.
Patients who underwent PE had a significantly shorter use of MV than those given IVIG, at a median of 11 and 13 days, respectively.
There was a trend toward a shorter time in the pediatric intensive care unit with PE than IVIG but this did not reach statistical significance. Ability to walk unaided was similar between the PE- and IVIG-treated groups, at 95.2% and 90%, respectively.
El-Bayoumi et al found that in PE-treated patients, there was a negative correlation between CSF protein levels and length of time spent on MV. However, no such relationship existed for IVIG-treated patients.
"This finding supports the above explanation of a shorter duration of MV in the PE group especially in view of a randomized controlled trial showing CSF filtration to be at least as effective as PE for treatment of GBS and the suggestion of a blood-CSF barrier dysfunction in adults and children with GBS," the authors comment.
The team notes that pediatric patients with rapidly progressing GBS are likely to have a high level of autoantibodies bound to nerves at the time of respiratory failure, and this may explain why PE removal of autoantibodies is more effective than blocking antibody production with IVIG.
"The finding of a negative correlation between CSF protein values and duration of MV in PE group might serve as a basis for future researches aiming at a better understanding of autoantibody kinetics during treatment of GBS," the researchers conclude.
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By Lynda Williams