<![CDATA[Background: Guillain-Barré Syndrome (GBS) is a progressive acute inflammatory polyradiculopathy caused by immune system dysregulation that carries a high risk of triggering respiratory failure. In its management, plasma exchange (PE) and intravena imunoglobulin (IVIG) is an essential primary therapeutic modality to eliminate pathological autoantibodies and inhibit disease progression. Although impending respiratory failure in GBS patients has been widely reported and is generally managed with invasive mechanical ventilation, literature discussing the successful use of an alternative approach utilizing non-invasive ventilation (NIV) combined with PE therapy remains highly limited.Case: We report a case of a 34-year-old male diagnosed with flaccid tetraparesis accompanied by dyspnea, suspected to be GBS. The clinical features, cerebrospinal fluid (CSF) analysis, and Electroneuromyography (ENMG) are indicative of GBS. During treatment in the intensive care unit (ICU), the patient received intravenous methylprednisolone therapy, PE, and respiratory support via NIV. The patient underwent intensive care for 13 days. Post-PE, the patient's clinical condition showed significant improvement, allowing for transfer to the general ward.Discussion: Managing respiratory weakness in GBS demands a delicate balance in ventilatory strategy: weighing the hazards of early invasive intubation against the high risk of aspiration or sudden failure when utilizing non-invasive support. Since the therapeutic benefits of PE are gradual, patients face a precarious window. Consequently, rigorous risk stratification and precisely tailored airway interventions are imperative to safely bridge the patient to recovery.Conclusion: In this case, the combination of PE therapy and appropriate airway management gradually improved clinical outcomes. A collaborative approach through a multidisciplinary team is essential in planning and executing optimal treatment strategies.]]>
