title: Critical management in patients with severe enterovirus 71 infection.
abstract: OBJECTIVE
  The aim of this study was to analyze clinical details occurring in children with severe enterovirus 71 (EV71) infection and synthesize the critical care experience for patients with severe EV71 infection.
  
  
  METHODS
  A retrospective clinical, laboratory, and hemodynamic study was performed in a pediatric intensive care unit in a university hospital. From March 1998 to April 2000, seven consecutive pediatric patients with severe EV71 infection were retrospectively analyzed as the comparison group. From May 2000 to March 2003, eight consecutive patients with severe EV71 infection who had received the protocol therapy were enrolled as the study group. Detailed information about clinical treatment and pharmacological therapy was collected for comparison.
  
  
  RESULTS
  The clinical presentations and laboratory findings between the comparison and the study groups were not significantly different. The amount of intravenous fluid in the first 24 h was significantly higher in the comparison group (9.2+/-5.0 vs 4.9+/-1.3 mL/kg per h). More patients in the study group received low doses of dopamine infusion, patients in the comparison group received more epinephrine, and none of them received milrinone. The acute-stage and long-term survival rates were higher in the study group (100% vs 43%, 87% vs 29%).
  
  
  CONCLUSIONS
  Early cardiopulmonary support may prevent the vicious cycle of cardiopulmonary failure and improve the clinical outcome of severe EV71 infection. Milrinone may be the ideal inotropic agent for these patients. Echocardiography, a central line, and an arterial line could be an alternate method to replace direct intracardiac hemodynamic monitoring for guiding critical management.
authors.affiliation: Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Jieh-Neng
authors.initials: JN
authors.lastname: Wang
authors.forename: Chih-Ta
authors.initials: CT
authors.lastname: Yao
authors.forename: Cheng-Nan
authors.initials: CN
authors.lastname: Yeh
authors.forename: Chao-Ching
authors.initials: CC
authors.lastname: Huang
authors.forename: Shih-Min
authors.initials: SM
authors.lastname: Wang
authors.forename: Ching-Chuan
authors.initials: CC
authors.lastname: Liu
authors.forename: Jing-Ming
authors.initials: JM
authors.lastname: Wu
mesh_terms: D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D004769:Enterovirus Infections / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006470:Hemorrhage / Q000503:physiopathology / Q000628:therapy / Q000821:virology*; D006801:Humans; D007223:Infant; D008297:Male; D011654:Pulmonary Edema / Q000503:physiopathology / Q000628:therapy / Q000821:virology*; D012189:Retrospective Studies; D016896:Treatment Outcome