General principles

The principles that govern management during mechanical ventilation centre upon three primary concerns - access to the airway with the provision of adequate pulmonary gas exchange, the maintenance of nutrition, and the prevention of nosocomial infection. Other issues, very often taken for granted but which require special attention, include: the need for scrupulous nursing care to avoid nerve compression syndromes and bed sores; physiotherapy with the provision of adequate analgesia and splints, to prevent irreversible contractures and joint immobilisation; subcutaneous heparin for the prophylaxis of deep venous thrombosis; and finally extensive psychological support during the period when patients are entirely dependent upon their attendants and the mechanical ventilator. Keeping a paralysed but conscious patient comfortable requires careful positioning and frequent gentle repositioning: sitting up, especially out of bed, may help and is good for morale. A particular problem in patients with GBS is the management of autonomic dysfunction, which can result in wide fluctuations in pulse and blood pressure as well as a wide variety of atrial and ventricular arrhythmias.48-50

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