Guillain-Barré Syndrome (GBS) — Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Respiratory/bulbar involvement?
   Acute ascending flaccid paralysis — respiratory/bulbar involvement or rapid progression? (Acute immune-mediated polyradiculoneuropathy, ~65% with an antecedent infection (1–3 weeks before). Bilateral ascending flaccid paralysis, areflexia ± sensory symptoms; may involve respiratory/bulbar/facial muscles, autonomic (arrhythmia, BP swings). Clinical diagnosis (Asbury), supported by CSF albuminocytologic dissociation (high protein, normal cell count; may take up to 1 week to appear, ~10% negative) + EMG. An emergency, ICU monitoring.)
   • Respiratory/bulbar involvement or rapid progression → Respiratory/bulbar involvement → ICU
   • Mild, stable, no respiratory involvement → Mild · monitor + immunotherapy
2. [End] Mild · monitor + immunotherapy
   Ambulatory, no respiratory/bulbar involvement: admit for close monitoring — serial forced vital capacity (FVC) and negative inspiratory force (NIF) (q6–8h), cardiac monitoring (autonomic); most moderate–severe cases need immunotherapy (IVIG 2 g/kg over 5 days or plasma exchange, equivalent, do not combine, steroids ineffective). VTE prophylaxis, rehabilitation. Escalate if progressing.
3. [End] Respiratory/bulbar involvement → ICU
   ICU. 1) Immunotherapy: IVIG 2 g/kg over 5 days or plasma exchange (as early as possible, equivalent, do not combine; corticosteroids are ineffective). 2) Respiratory monitoring: serial FVC/NIF — FVC <15–20 mL/kg, declining NIF or bulbar weakness with aspiration risk → intubation and mechanical ventilation (do not wait for blood gases to deteriorate). 3) Autonomic: cardiac monitoring, manage arrhythmia/BP swings. 4) VTE prophylaxis, pain management, nutrition, rehabilitation.

Source guidelines & references

• Guillain-Barré syndrome (Merck Manual; AMBOSS); Asbury diagnostic criteria

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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