Modified plasma exchange in life-threatening Guillain-Barre syndrome - abstract

ABSTRACT

Modified plasma exchange (MPE), a simpler procedure than a conventional plasmapheresis which uses automated equipment and expensive replacement fluids, has recently been recommended for use in hospitals with limited resources in the management of patients with Guillain-Barre Syndrome (GBS). We have performed MPE in 7 patients with life-threatening respiratory failure due to GBS, using fresh frozen plasma as replacement fluid. In 5 out of 6 patients, in whom MPE was started at the onset of mechanical ventilation, rapid improvement inconsistent with the natural history of the disease was noted. In 2 of these patients, due to severity of illness, more plasma per day than previously recommended was safely removed. In one patient, MPE was started with a peak expiration flow rate of 2.2 litres per minute and assisted ventilation was unnecessary due to rapid improvement. Death occurred in one patient from respiratory complications and was not directly due to MPE. Our study confirms the safety and efficacy of MPE and suggests that more plasma can be safely exhanged by this method than previously recommended (AU)