Supportive treatment Respiratory care

Regular chest physiotherapy and spirometry are required. Mechanical ventilation is needed if FVC <1l or PaCO2 is raised. An early tracheostomy is useful since mechanical ventilation is likely to continue for several weeks. Patients with bulbar involvement or inadequate cough should undergo tracheotomy, even if spontaneous breathing continues.

Cardiovascular care

Continuous cardiovascular monitoring is required due to the effects of autonomic involvement. Arrhythmias are particularly likely with anaesthesia (especially with suxamethonium). Hypertensive and hypotensive responses are generally exaggerated with vasoactive drugs.

Nutritional support

Parenteral nutrition will be required in cases where there is ileus. Enteral nutrition is preferred, if possible, even though energy and fluid requirements are reduced in Guillain-Barre syndrome.

Analgesia

Analgesia is required for muscle, abdominal and back pain. Although NSAIDs may be useful, opiates are often required.

Other support

Particular attention is required to pressure areas and deep vein thrombosis prophylaxis.

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