Neurocit Carehttps::/dol.org/10.1007s12028-023-01707-3NEURCRITICALCARE SOCIETYNCS GUIDELINESGuidelines for Neuroprognosticationin Adults with Guillain-Barre SyndromeKatharina M.Busl',Herbert Fried2,Susanne Muehlschlegel3,Katja E.Wartenberg,Venkatakrishna Rajajee5,Sheila A.Alexander,Claire J.Creutzfeldt',Gabriel V.Fontaine,Sara E.Hocker,David Y.Hwang0,KeriS.Kim1Dominik Madzar2,Dea Mahanes13,Shraddha Mainali14,Juergen Meixensberger15,Oliver W.Sakowitz,Panayiotis N.Varelas,Thomas Westermaier and Christian Weimar2023 The Author(s)AbstractBackground:Guillain-Barre syndrome(GBS)often carries a favorable prognosis.Of adult patients with GBS,10-30%require mechanical ventilation during the acute phase of the disease.After the acute phase,the focus shifts to res-toration of motor strength,ambulation,and neurological function,with variable speed and degree of recovery.Theobjective of these guidelines is to provide recommendations on the reliability of select clinical predictors that serve asthe basis of neuroprognostication and provide guidance to clinicians counseling adult patients with GBS and/or theirsurrogates.Methods:A narrative systematic review was completed using Grading of Recommendations Assessment,Develop-ment and Evaluation(GRADE)methodology.Candidate predictors,including clinical variables and prediction models,were selected based on clinical relevance and presence of appropriate body of evidence.The Population/Interven-tion/Comparator/Outcome/Time frame/Setting (PICOTS)question was framed as follows:"When counseling patientsor surrogates of critically ill patients with Guillain-Barre syndrome,should [predictor,with time ofassessment if appro-priate]be considered a reliable predictor of [outcome,with time frame of assessment]?"Additional full-text screeningcriteria were used to exclude small and lower quality studies.Following construction of an evidence profile and sum-mary of findings,recommendations were based on four GRADE criteria:quality of evidence,balance of desirable andundesirable consequences,values and preferences,and resource use.In addition,good practice recommendationsaddressed essential principles of neuroprognostication that could not be framed in PICOTS format.Results:Eight candidate clinical variables and six prediction models were selected.A total of 45 articles met oureligibility criteria to guide recommendations.We recommend bulbar weakness(the degree of motor weakness at dis-ease nadir)and the Erasmus GBS Respiratory Insufficiency Score as moderately reliable for prediction of the need formechanical ventilation.The Erasmus GBS Outcome Score(EGOS)and modified EGOS were identified as moderatelyreliable predictors of independent ambulation at 3 months and beyond.Good practice recommendations includeconsideration of both acute and recovery phases of the disease during prognostication,discussion ofthe possibleneed for mechanical ventilation and enteral nutrition during counseling,and consideration of the complete clinicalcond
