Characteristics of ventilator weaning in patients intubated for Guillain-Barré syndrome or myasthenia gravis: a nationwide multicenter study

Abstract

Purpose: Severe forms of Guillain-Barré syndrome (GBS) and myasthenia gravis (MG) may result in prolonged mechanical ventilation in ICUs. Data on weaning from mechanical ventilation are scarce, and our objective was to assess ventilator weaning characteristics in a large-scale multicenter study.

Methods: Multicenter retrospective cohort study including all patients intubated for at least 48 h for GBS or MG over a 10-year period (from January 2014 to December 2023). The primary outcome was the proportion of patients having experienced prolonged weaning (at least 7 days).

Results: Some 886 patients admitted to 47 ICUs in France were retained in the analysis, including 513 (58%) with GBS and 373 (42%) with MG. Patients with GBS were more likely to experience prolonged weaning than those with MG (64% vs. 35%, p < 0.001). An extubation attempt was performed in only 46% of patients with GBS and in 88% patients with MG (p < 0.001). Reintubation rates were 26% in patients with GBS and 29% in patients with MG (p = 0.440). Patients with GBS were more likely to undergo tracheostomy than those with MG (57% vs. 17%, p < 0.001). Patients with GBS required a longer duration of mechanical ventilation and ICU stay. Mortality rates were similar (9.4% for patients with GBS and 9.7% for patients with MG, p = 0.882).

Conclusions: Patients with GBS were more likely to experience prolonged weaning and to undergo tracheostomy than patients with MG. More than one-fourth of patients required reintubation after an extubation attempt. Despite prolonged duration of mechanical ventilation, mortality remained relatively low.

Keywords: Airway extubation; Guillain–Barré syndrome; Intensive care unit; Myasthenia gravis; Tracheostomy; Ventilator weaning.