Correlation of Modified EGRIS with the Risk of Mechanical Ventilation in GBS

Dr. Sohini Ganji, Dr. Veena Narisetty, Dr. Akhilesh Kumar, Dr. A. Goutami Priyadarshini

Abstract: Introduction: Guillain?Barre syndrome (GBS) is an acute onset rapidly progressive disease due to inflammation of the peripheral nervous system and is one of the commonest causes of flaccid paralysis. Involvement of the respiratory muscles causes the life threatening complication of respiratory failure requiring the need of mechanical ventilation, seen in up to 22% within the first week. Prompt recognition of these patients at increased risk of respiratory failure in GBS is needed to triage them and shift them timely to a respiratory intensive care unit. Modified Erasmus GBS Respiratory Insuffiency Score (mEGRIS) is a bedside clinical score based on 4 parameters, duration of onset of weakness until admission, presence or absence of bulbar palsy, neck power and power of bilateral hip flexion. It can be used to predict MV risk at different time points during admission course and is applied in all GBS variants. Here we present 56 cases of GBS where the mEGRIS score was used to predict the risk of MV. Clinical Methods: 56 patients who met the criteria for GBS and admitted in Neurology Department were enrolled. They were evaluated by de-tailed examination, routine investigations, CSF and NCS. The mEGRIS score was used to triage patients who require MV. Results: In our study, out of 56 patients, 26 were male and 30 were female. AMSAN was MC presentation in 38 patients.19 had bulbar involvement, 16 required MV out of which 7 patients died. The cause of death was septic shock in 2 patients, PTE in 1 patient and autonomic fluctuations in 1 patient. 2 patients succumbed to underlying comorbidities. All patients who required MV had high mEGRIS score at presentation. Conclusion: The mEGRIS is a rapid score that predicts the risk of MV in GBS which helps in triaging patients.

Keywords: GBS, mechanical ventilation, respiratory insufficiency, bulbar weakness, triage