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Answer 4
  1. Forced vital capacity. Patients with GBS or suspected GBS are best monitored in the intensive care unit. Approximately one third of patients with GBS develop respiratory muscle weakness requiring mechanical ventilation. The most reliable parameters of neuromuscular respiratory muscle (ventilatory) weakness are forced vital capacity (FVC) and negative inspiratory pressure. Intubation should be strongly considered if the FVC decreases to below 12 to 15 mL/kg body weight. Arterial blood gases and pulse oximetry are important but less sensitive measures of ventilation. The pupillary reflex is not affected by GBS, although autonomic nerve involvement may result in labile blood pressure, urinary retention, and cardiac arrhythmia. Changes in mental status are not seen in GBS unless associated with hypercapnia or hypoxia; however, acute intermittent porphyria may present as an acute polyneuropathy and encephalopathy.

     Pascuzzi RM, Fleck JD. Acute peripheral neuropathy in adults. Guillain-Barré syndrome and related disorders. Neurol Clin 1997;15:529-47.

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