New therapeutic target for osteoarthritis: modulating immune-metabolic aberrations and micromilieu remodeling in underlying bone.

Severe forms of Guillain-Barré syndrome (GBS) may lead to acute respiratory failure and a need for intubation and mechanical ventilation [, , , ]. While respiratory failure is due primarily to respiratory muscle weakness, it can also be caused by bulbar weakness, leading to swallowing disorders that potentially result in aspiration pneumonia. Once intubated, these patients require particularly prolonged duration of mechanical ventilation in intensive care units (ICUs) and frequently present ventilator weaning difficulties []. The need for tracheostomy commonly appears while awaiting neuromuscular recovery sufficient to allow physiological spontaneous ventilation, as well as the restoration of effective cough and swallowing capacity [, , , , , , ]. However, data on ventilator weaning in these patients are scarce and primarily come from small-scale, often single-center, retrospective studies [, , , , , , ]. A recent narrative review on GBS acknowledged that due to the limited number of studies, ventilator weaning modalities were primarily based on expert opinions []. Moreover, a systematic review underscored a lack of studies showing the benefits of any specific weaning protocol in mechanically ventilated patients with neuromuscular disease []. In a recent, large-scale, multicenter, nationwide study, we described the characteristics of ventilator weaning in patients with GBS []. The main findings were that most patients experienced prolonged weaning, and that nearly 60% of patients underwent tracheostomy. Tracheostomy was performed either directly without any prior weaning attempt (i.e., neither spontaneous-breathing trial (SBT) nor extubation attempt), or after weaning failure (i.e., after repeated SBT failure or after extubation failure leading to reintubation). Whether or not a direct tracheostomy is beneficial in patients intubated for GBS remains to be determined. On the one hand, a direct tracheostomy in patients who could have been extubated through a standard weaning process may have detrimental effects by delaying ventilator weaning. On the other hand, a direct tracheostomy after intubation may result in early liberation from mechanical ventilation as compared to patients undergoing tracheostomy after weaning failure, which could actually be beneficial. Therefore, we aimed to assess the effects of direct tracheostomy on outcomes of patients mechanically ventilated for GBS, as compared to patients having undergone a standard weaning process that included at least one SBT or an attempt at extubation. We also compared the effects of direct tracheostomy with tracheostomy performed after weaning failure.