CONTEXT: The combination of multiple clinical factors culminates in neuromuscular @entity1576 in up to 30% of the @entity1 with @entity5011 ( @entity5011 ). Although guidelines exist as to when to proceed with intubation, early indicators of subsequent progression to @entity1576 have not been established. OBJECTIVES: To identify clinical and respiratory features associated with progression to @entity1576 and to examine patterns of respiratory decline in @entity1 with severe @entity5011 . DESIGN: Retrospective survey. SETTING: Tertiary care hospital. @entity1 : One hundred fourteen consecutive @entity1 with severe @entity5011 admitted to the intensive care unit between January 1, 1976, and December 31, 1996. MAIN OUTCOME MEASURES: Early markers of impending @entity1576 , requirement for mechanical ventilation, and patterns of respiratory decline. METHODS: The clinical and electrophysiologic features of 60 @entity1 receiving mechanical ventilation were compared with 54 @entity1 with severe @entity5011 who did not receive mechanical ventilation. Daily preventilation maximal inspiratory and maximal expiratory respiratory pressures and vital capacity were analyzed. Multivariate predictors of the necessity for mechanical ventilation were assessed using logistic regression analysis. RESULTS: Progression to mechanical ventilation was highly likely to occur in those @entity1 with rapid disease progression, @entity409 , bilateral @entity425 , or @entity8053 . Factors associated with progression to @entity1576 included vital capacity of less than 20 mL/kg, maximal inspiratory pressure less than 30 cm @entity2507 , maximal expiratory pressure less than 40 cm @entity2507 or a reduction of more than 30% in vital capacity, maximal inspiratory pressure, or maximal expiratory pressure. No clinical features predicted the pattern of respiratory decline; however, serial measurements of pulmonary function tests allowed detection of those at risk for @entity1576 . CONCLUSIONS: While inherently unpredictable, the course of @entity1 with severe @entity5011 can, to some extent, be predicted on the basis of clinical information and simple bedside tests of respiratory function. These data may be used in the decisions regarding admission to the intensive care unit and preparation for elective intubation.

Anticipating mechanical ventilation in XXXX .

@entity1 :: ('9606', 'Species') :: ['patients', 'PATIENTS'] @entity409 :: ('MESH:D008107', 'Disease') :: ['bulbar dysfunction'] @entity425 :: ('MESH:D018908', 'Disease') :: ['facial weakness'] @entity2507 :: ('CHEBI:33813', 'Chemical') :: ['H(2)O'] @entity5011 :: ('MESH:D020275', 'Disease') :: ['GBS', 'Guillain-Barr   syndrome'] @entity1576 :: ('MESH:D012131', 'Disease') :: ['respiratory failure'] @entity8053 :: ('MESH:D054969', 'Disease') :: ['dysautonomia']
@entity5011 :: (MESH:D020275,Disease) :: ['Guillain-Barr   syndrome']
