1997 OPEN FORUM Abstracts
APPLICATION OF THE CLINICAL RESEARCH 'LMG' PROTOCOL IN WEANING FROM MECHANICAL VENTILATION(MV)IN CHILDREN WITH GUILLAIN-BARRE SYNDROME (GBS)
Gustavo Olguin PT, Claudia Rossello PT, Luisa Maria Giorgetti PT. Garrahan Pediatric Hospital, Physical Therapist Department. Buenos Aires, Argentina.
We sought to validate a clinical research protocol (LMG) that (1) establishes the basic clinical and physiologic criteria for entering neuromuscular patients into a program of training for weaning, (2) incorporates a score for effectiveness of respiratory mechanics, and (3) provides a program of active training to overcome muscle weakness. Materials & Methods: From 1989-1998 14 patients with GBS were treated in our ICU -- 8 with acute demyelinating neuropathy (ADN) and 6 with motor or axonal neuropathy-like variants. Patients ranged in age from 10 months to 15 years, 6 girls and 8 boys. All required mechanical ventilation (MV) -- 12 for progressive ventilatory incapacity and 2 for acute respiratory pathology. Criteria for entry into weaning training were (1) no acute pulmonary pathology for minimum of 48 h; stable MV PaO2 >= 60 mm Hg, PaCO2 < = 45 mm Hg, and SaO2 >= 95%. Respiratory mechanical effectiveness (DRME) was determined from our Clinical Score, with 9-13 being Good; 4.5-8.5 Regular; 2-4 Poor; and 0-1.5 Vestige/Disappeared. The weaning plan was initiated on patients whose score was >= 4.5 and with supplemental oxygen if required. Limit time (LT) was determined and from LT Working Time (WT, or time off of MV, equivalent to 75% of LT). Training schedule consists of 3 periods of disconnection (WT) alternating with periods of rest on MV. Every 2 days DRME was reexamined and a new LT-WT determined, reflecting progress in training weakened muscles. After 2 daily disconnections of 5 h, the next step was disconnection for 12 hours for 2 days, and then permanent disconnection with extubation. Results: Weaning was possible with scores >= 6 Weaning initiated with scores between 6 and 11 and no acute respiratory complications lead to achieving weaning in 100% of patients between Day 2 and Day 16 with a mean of 8 days. Commentary: Protocol implementation permits us to predict a mean weaning time of 8 days. The cost/benefit relation is important. We are convinced that this Protocol can be successful and is economical and could be applied to other respiratory pathologies that require lengthy MV.