Guillain-Barré Syndrome particularly burdens patients who need mechanical ventilation. In one of three patients, it becomes obvious early in the disease that respiratory rate is increased followed by reduction in tidal volume due to fatigue. Many patients are sweaty, have a rapid pulse, and can hardly express their shortness of breath by words. Endotracheal intubation follows and breathing is assisted using a combination of machine initiated breathing and spontaneous ventilation. This mode of ventilation is usually tolerated, although adaptions may be difficult in the first hours. Some sort of sedation while still easily accusable may be helpful (e.g., Precedex®). Intubation should be done early during the day assuring the patient it is a temporary measure and weaning is expected. Postponing intubation may lead to so-called ''crash'' intubation in the middle of the night which may have additional complications. Time on the ventilator varies but most modern intensive care series report a median of 30 days. A tracheotomy is soon considered. In the vast majority of patients, this is usually postponed until the third week after intubation, but in patients with profound bulbar symptoms or in those in which severe damage to the axons a surgical tracheostomy could be considered earlier. The timing of tracheostomy is quite complex. Recent studies done at Mayo Clinic have surfaced new and interesting findings. From a retrospective review of 60 patients who were mechanically ventilated following GBS, it was found that serial baseline pulmonary function test (vital capacity and bugle pressures) can in some way indicate the readiness of weaning. This scoring system accurately predicts the duration of ventilation greater than 3 weeks. It was possible to wean patients off the mechanical ventilator before tracheostomy could be placed. Another study in GBS patents found that the time on the ventilator was strongly associated with respiratory tract complications. Only a few patients who were mechanically ventilated for greater than three weeks do not have respiratory complications. Diffuse pneumonitis occurs in half of the patients who require mechanical ventilation. Aggressive management of atelectasis, tracheal secretions, and avoidance of corticosteroids that might increase the risk of these infections is critical. A surveillance system of respiratory infections may be other appropriate measures to reduce the severity of infections that could limit the time on the ventilator. Mechanical ventilation is a lifesaving measure in the severe form of Guillain-Barré Syndrome, but once on the ventilator, management remains a contentious issue. The timing of tracheostomy is important because deforming tracheostomy scars can be avoided in a few patients. We do not know whether lungs return back to normal in patients who have been on a mechanical ventilator and did not have underlying lung disease. These critical care issues deserve much attention.