High flow oxygen therapy via tracheostomy to wean from Guillain- Barre Syndrome associated prolonged mechanical ventilation: A case report

Guillain- Barre Syndrome (GBS) is an autoimmune condition that can cause life-threatening respiratory failure, necessitating prolonged mechanical ventilation (MV). High flow oxygen can also be administered through a tracheostomy (HFOT) with an adapter, although evidence for its benefit in difficult-to-wean tracheostomized patients is scarce. A 60-year-old male with acute myeloid leukemia (AML) underwent allogeneic stem cell transplantation and achieved complete remission. Six months later, he developed GBS involving limb and respiratory muscle paralysis. Negative inspiratory force was -15 cm H2O. He required endotracheal intubation, tracheostomy, and treatment with Rituximab and immunoglobulin. For more than two months on the ventilator repeated trials of tracheostomy collar were unsuccessful. After 78 days on the ventilator, HFOT via tracheal adapter with 50% FiO2 at 60 L/min was introduced daily, initially for 1h for the first couple of days, then 3h twice a day, and increased as tolerated to 24 h. After 99 days of either intermittent or continuous ventilator support, he tolerated 24 h off ventilator on HFOT and was transitioned to tracheostomy collar, decannulated, and discharged to rehab after five months. Our case highlights successful use of high flow oxygen via tracheostomy (HFOT) in a difficult-to-wean patient with Guillain-Barre Syndrome.