GBS vs CIP

OVERVIEW

  • GBS and CIP are important causes of weakness in ICU and distinguishing between them is important due to the management and prognostic implications
    • Guillain-Barré Syndrome (GBS)
    • Critical Illness Polyneuropathy (CIP)
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GBSCIP
History
  • Recent GI or resp illness.
  • Progressive bilateral symmetric paralysis.
  • Subtypes can be more localized e.g. MF ophthalmoplegia and ataxia.
  • Sensory involvement is common.
  • Areflexic.
  • Autonomic involvement may be present
  • Always occurs in association  with a critical illness in particular severe sepsis.
  • May have an association with encephalopathy in early stages.
  • It is a symmetrical weakness.
  • May have muscle tenderness, hyporeflexic, diminished distal sensation
  • Not associated with autonomic involvement
Examination
  • Albuminocytologic dissociation in CSF.
  • Identification of infection with campylobacter, mycoplasma, EBV,Varicella, CMV.
  • Elevated CSF IgG levels and possible serum antiganglioside antibodies
  • Elevated CK which may be transient.
Investigations
  • When demyelinating form is present, you get a reduction in conduction velocity as well as reduction in CMAP
  • In axonal forms however it is only the distribution of the findings that helps determine the diagnosis
  • Axonal neuropathy resulting in a decreased CMAP without a reduction in conduction velocity

References and Links


CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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