Intensive Care Med (2006) 32:1962–1969 DOI 10.1007/s00134-006-0332-1 ORIGINAL David Orlikowski Tarek Sharshar Raphael Porcher Djillali Annane Jean Claude Raphael Bernard Clair Prognosis and risk factors of early onset pneumonia in ventilated patients with Guillain–Barré syndrome Received: 28 March 2006 Accepted: 21 July 2006 Published online: 21 September 2006 © Springer-Verlag 2006 D. Orlikowski · T. Sharshar · D. Annane · J. C. Raphael · B. Clair (✉) Raymond Poincaré Teaching Hospital, Medical Intensive Care Unit, 104 boulevard Raymond Poincaré, 92380 Garches, France e-mail: Bernard.clair@rpc.ap-hop-paris.fr Tel.: +33-1-47107780 Fax: +33-1-47107783 R. Porcher Saint Louis Teaching Hospital, Biostatistics and Medical Computer Science Department, 10 rue Claude Vellefaux, 75475, 75010 Paris, France Abstract Objective: Invasive mech- anical ventilation is required in 30% of patients with Guillain–Barré syn- drome (GBS) and is associated with pneumonia and increased mortality. Our objective was to determine the incidence, characteristics, outcomes, and risk factors of pneumonia in GBS patients receiving mechanical ventilation. Design and setting: Study of a prospective database in an intensive care unit of a university hos- pital. Patients: The study included 81 patients who required intubation for GBS. Neurological findings, vital capacity, and signs of respiratory distress were recorded at admission and at intubation. A score predicting the risk of intubation (0–4) was cal- culated for each patient. Pneumonia was diagnosed based on predefined criteria and retrospectively confirmed by two observers. Early-onset pneu- monia was defined as pneumonia diagnosed within 5 days after intu- bation. Measurements and results: Mean vital capacity was 57 ± 22% of predicted at admission and 33 ± 11% at intubation. Pneumonia developed in 63 patients (78%), including 48 with early-onset pneumonia. Bacteria were consistent with aspiration. Of the 63 patients with pneumonia 11 (18%) had septic shock, 6 (10%) had acute respiratory distress syndrome, and 9 (14%) died. In the univariate analysis milder weakness, a lower risk of intubation (score < 2), and time from admission to intubation longer than 2 days were associated with early-onset pneumonia. Time from admission to intubation was the only independent predictor in the multivariate logistic regression model. Conclusions: Early-onset pneumonia is a common and severe complication that is related to aspira- tion in patients with GBS. Delaying intubation may increase the risk of early-onset pneumonia. Keywords Aspiration · Mechanical ventilation · Intubation · Early- onset pneumonia · Guillain–Barré syndrome Introduction Guillain–Barré syndrome (GBS) is the most common cause of acute neuromuscular paralysis in industrial- ized countries, with an incidence ranging from 0.4 to 4 per 100,000 population [1]. The most severe com- plication of GBS is respiratory failure, which occurs in 20–30% of patients [2, 3, 4]. Respiratory muscle weakness leads to hypoventilation, impaired coughing, secretion retention, and atelectasis. Bulbar dysfunction often contributes to respiratory failure by causing as- piration, which has been documented in about half of all mechanically ventilated patients with GBS [5]. The risk of pneumonia increases with the severity of muscle weakness, being highest in ventilated patients and chiefly related to aspiration [4, 6]. Pneumonia is associated with increased mortality [7]. Therefore decreasing the occurrence of pneumonia would be expected to im-