1125 - From Respiratory Distress to Respiratory Success after GBS: A Case of Specialized Rehabilitation for a Child with Guillain-Barre Syndrome Requiring Mechanical Ventilation

This is a four-year-old female with history of prematurity with a 100-day NICU stay, sexual differentiation disorder, and right pseudohypertrophy who was diagnosed with GBS by lumbar puncture after developing acute weakness and respiratory distress. She was intubated, had a tracheostomy placed, and was treated with plasmapheresis and intravenous immunoglobulin. At our inpatient rehabilitation facility, a point-of-care dynamic ultrasound of her diaphragm was performed by a neuromuscular specialist, and she was deemed a good candidate for cardiopulmonary rehabilitation. She has been working with a Physical Therapist who specializes in this type of therapy on thoraco-abdominal pressure regulation, respiratory muscle strengthening, chest wall mobility, cough strength, and use of respiratory muscles to assist with functional mobility. As a result, she has been weaned off mechanical ventilation and has begun tracheostomy capping trials with the goal of decannulation soon.

Discussions:

This case highlights the advantage of having experts in performing diaphragmatic ultrasounds and in providing cardiopulmonary rehabilitation for children with respiratory complications. Incorporating these techniques into rehabilitation would likely improve outcomes overall, particularly in weaning mechanical ventilation and in tracheostomy decannulation. Additionally, this patient’s complex premorbid medical history resulted in anxiety with any contact to her lower extremities, adding an extra layer of complexity to the rehabilitation process of her GBS with respiratory distress.

Conclusions:

Children with life-threatening respiratory complications from GBS are some of the most complex patients in need of comprehensive rehabilitation. As demonstrated by this case, their function could significantly improve by incorporating specialized cardiopulmonary rehabilitation after having diaphragmatic ultrasound evaluations.