Guillain-Barré Syndrome: Treatment (Nursing)

00:00 Now, sadly, there is no known cure.

00:04 It's kind of a long process but our treatment goal is to lessen the severity and shorten the recovery time, that's our goal, so we wanna make sure that it doesn't progress up to respiratory paralysis, if possible, and we want the patient to have a shorter recovery time so they can return to their normal life quicker.

00:24 So Guillain-Barre patients are usually admitted to critical care units because we wanna watch them very closely.

00:31 If they are in a med-surg unit, they would be behind the door, not visible by nurses, you don't have the opportunity to observe your patients as closely.

00:39 Now, a telemetry unit would be one where they have a portable monitor, right, but you still don't usually have direct visualization of the patient.

00:48 In a critical care unit you have direct visualization of your patients, they're on a cardiac monitor, they're probably on a pulse ox especially for Guillain-Barre and those readings will be available at the nurse's desk and to the cardiac unit that where the text are just monitoring cardiac rhythm.

01:07 So it's a logical place, it's a safer place to put a patient that we're worried about having respiratory problems in the critical care unit where they can be observed.

01:17 Now if they progress well with the treatment they may only be there for a short time, if we can't shorten that severity, they may end up staying in that unit longer.

01:26 So we're looking at the treatments for Guillain-Barre.

01:29 Now, here we're gonna look at plasmapheresis versus immunoglobulin therapy.

01:34 Let me just tell you, it's a tie.

01:37 The key point is start the treatment within two weeks of the symptoms so within two weeks of onset of the initial symptoms, we need to start that treatment that was what makes it most effective.

01:49 Is plasmapheresis more effective than immunoglobulin therapy? Not really. Either one is effective.

01:56 Maybe you can find that trying to mix them or one after the other really doesn't make a significant difference, so the health care team will decide which one is most appropriate based on resources or your patient but both are good.

02:10 Let's talk about what they are.

02:11 Plasmapheresis is a plasma exchange so look at the graphic there.

02:17 You see that 55% of your blood volume is plasma, less than 1% is your white cells and platelets, and about 45% are your red cells.

02:26 So here's what happens in plasmapheresis, they take the blood out of the patient, they'll removed some plasma and return just the red blood cells.

02:36 So, the plasma is the part that contains the antibodies, now, remember, we're having problems with the peripheral nervous system being attacked in Guillain-Barre Syndrome.

02:45 So they'll remove the plasma and then they'll either treat it and they'll return just the red blood cells.

02:51 Now your body will kick it up and will replace that plasma volume.

02:55 They don't replace all of your plasma in plasmapheresis.

03:00 You'll do a series of treatments; but when that plasma is removed, your own body will replace those other plasma volume otherwise, if its problematic, you can also receive a unit of plasma so they can give you from donors just to replace the plasma volume if the body is not able to keep up.

03:18 So plasmapheresis, blood goes out, plasma removed, red cells are returned, remember, those are the oxygen carrying component.

03:28 Now they may or may not give you an additional unit of donor plasma, we'll just have to see how each patient progresses.

03:35 Okay, so that's plasmapheresis.

03:39 Now we're gonna talk about immunoglobulin therapy and this is high dose immunoglobulin therapy.

03:45 These are proteins, right? Immunoglobulins are proteins that are made in the body to attack affecting organisms.

03:52 Now we take IVIg from a large pool of donors so they're gonna give the patient a donation from a large pool of donors of this immunoglobulin, so this helps the patient by lowering the effectiveness of the nerve attacking antibodies because now they're diluted.

04:12 We're giving you this donation from a large pool of donors so they're now diluted with non-specific antibodies so all the antibodies that are present in that donor pool are now put into your patient with Guillain-Barre that's what helps dilute the nerve attacking antibodies.

04:29 This gives antibodies a combined a harmful antibodies and it will neutralize them.

04:34 So plasmapheresis, immunoglobulin therapy, they're both effective.

04:39 Plasmapheresis just involves removing the blood and putting back in the red cells getting rid of the plasma.

04:46 High dose immunoglobulin therapy requires the donation from a large pool of donors but both work and both are effective.