Challenges in managing prolonged intensive care unit stay for Guillain–Barré syndrome–acute motor axonal neuropathy variant

Guillain–Barré syndrome is a clinical syndrome manifesting as immune-mediated polyneuropathy. Approximately one-third of affected patients develop respiratory failure, necessitating intensive care unit admission and invasive mechanical ventilation. Multiple factors present at the onset and during intensive care unit stay are established predictors of the requirement for invasive mechanical ventilation. These include the rapid progression of motor weakness, concurrent involvement of peripheral limb and axial muscles, ineffective cough, bulbar muscle weakness, and the decline in rapid vital capacity. However, no reliable criteria currently exist to predict the duration of muscle weakness progression and plateau phases or the time to recovery. We herein report a case of a 55-year-old male admitted to the intensive care unit following a 5-day history of progressive ascending generalized weakness. His condition progressed to quadriplegia, diaphragmatic paralysis, and autonomic dysfunction. A diagnosis of Guillain–Barré syndrome–acute motor axonal neuropathy variant was confirmed via neurological examination, imaging, cerebrospinal fluid analysis, and nerve conduction studies. The patient exhibited no clinical improvement following two courses of five sessions each of plasma exchange and intravenous immunoglobulin. Owing to the refractory nature of his condition, he required more than 5 months of step-down intensive care unit care prior to transfer to a general medical ward and subsequent discharge home on hospital day 182.