Children with Guillian- Barre: 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  Intravenous immunoglobulin- neutralizes harmful antibodies  Plasma Exchange/Plasmapheresis  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:  Ineffective breathing pattern r/t respiratory muscle weakness or paralysis  Patient outcome  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 Faust C..Orlando's deliberative nursing process theory: a practice application in an extended care facility. J Gerontol Nurs Jul;28(7):14-8