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Báo cáo y học: " Functional markers to predict the need for prolonged mechanical ventilation in patients with Guillain-Barré syndrome"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Functional markers to predict the need for prolonged mechanical ventilation in patients with Guillain-Barré syndrome. | Zhang et al. Critical Care 2011 15 426 http ccforum.eom content 15 3 426 CRITICAL CARE LETTER L_ Functional markers to predict the need for prolonged mechanical ventilation in patients with Guillain-Barré syndrome Hongliang Zhang Tao Jin and Jiang Wu See related research by Fourrier etal. http ccforum.eom content 15 1 R65 We read with great interest the article by Fourrier and colleagues 1 who investigated functional markers to predict the need for prolonged mechanical ventilation MV in patients with Guillain-Barré syndrome GBS and acute respiratory failure. The study was well conducted but we are concerned about the study design and the confounding factors. Firstly we want to know why the authors chose 15 days as a cutoff point of MV duration. As mentioned in the article tracheotomy is indicated in GBS patients when a long duration of MV is expected 1 . Although the optimal time for performing tracheotomy is not well known it is usually considered after 3 weeks of prolonged MV 2 . In this context we are eager to know whether the lack of foot flexion ability was associated with a MV length of more than 21 days. If so it might be used as a predictor for tracheotomy. Secondly the authors seem to equate MV with endotracheal MV in their research. We therefore want to ask whether the authors used non-invasive mask MV in patients at the very early stages of respiratory failure. Thirdly delay between disease onset and admission or initiation of immunotherapy seems to differ among GBS patients. This may confound the data analysis since the predictive values of foot flexion ability may differ between patients beginning to receive immunotherapy from the recovery stage and from the acute stage 3 . Lastly although immunotherapy can change the natural course of GBS other factors may act in an opposite way. Complicated infections and electrolyte disorders 4 may aggravate respiratory muscle weakness and lead to prolonged use of MV. Author s response Francois Fourrier and .