Brighton diagnostic criteria for GBS can be found in Table 1.
High- dose intravenous immunoglobulin (IVIG) (2gr/kg) over 5 days and heat therapy were started 24 hours after the hospitalization.
Nevertheless, limb ’ weakness got worse and severe respiratory failure developed almost 11 days after admission. The patient was transferred to the Intensive Care Unit (ICU) and required mechanical ventilation.
According to the clinical and arterial blood gases (ABG) parameters the patient stared a cycle of non-invasive ventilation (NIV) with helmet interface in assist pressure control ventilation (APCV) mode (PS 1O mmHg, PEEP 7 mmHg, FiO2 60%) with good response.
She also stared intravenous continuous infusion of dexmedetomidine (0,8 γ/kg/h) with a Glasgow coma scale (GCS) 15 and a plasmapheresis cycles of five sessions 48 hours after the hospitalization in the intensive care unit. At the end of the plasmapheresis cycle, a new neurological assessment revealed a mild improvement of the neurological system
After nine days, considering the clinical and hemodynamic stability (FC 58 bpm, SpO2 98%, PA 111/56 mmHg), the good respiratory mechanics and the invariability of the neurological clinical picture the patient ended the NIV cycle and a Venturi mask at FiO2 60% was applied. She also started a plasmapheresis cycles of five sessions 48 hours after the hospitalization in the intensive care unit.
At the end of the plasmapheresis cycle, a new neurological assessment revealed a mild improvement of the neurological system. Therefore, the patient was moved from the ICU to the Neurology department.
During the hospitalization, the patient started presenting problems of psycho-motor agitation treated with the administration of antipsychotic drugs such as an aliphatic phenothiazine neuroleptic. The hyposthenia of the lower limbs raised and the patient started showing bilateral Bell’s palsy. Simultaneously, a deterioration of respiratory function arised, and the patient was treated once again with the application of oxygen therapy (FiO2 50%).
A new plasmapheresis cycle was started but based on the results of the emogas analysis (pH 7.45, pO2 51 mmHg, pCO2 30 mmHg) and considering the vital signs (FC 120 bpm, SpO2 80%, PA 170/80 mmHg), the patient was once again transferred to ICU where she started a new cycle of NIV with helmet interface in pressure support ventilation (PSV) mode (PS 12 cmH2O; PEEP 10; FiO2 100%) and intravenous continuous infusion of dexmedetomidine (0,6 γ/kg/h) considering the psychomotor agitation.
Almost 14 hours after admission in the Intensive Care Unit (ICU) the control arterial blood gases (ABG) revealed a serious deterioration of respiratory gas exchange. The patient was intubated and connected to the Mechanical Artificial Ventilation (VAM).
One hour after intubation the electrocardiogram heart tracing revealed ST segment depression, severe bradycardia (FC 20 bpm) with following cardiac arrest. Cardiopulmonary resuscitation maneuvers with the use of an automatic external defibrillator were performed according to Advanced Cardiovascular Life Support (ACLS).
After 30 minutes there was no evidence of cardiac response so the patient’s death was declared.