Critical management in patients with severe enterovirus 71 infection.
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.
Wang
Jieh-Neng
JN
Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Yao
Chih-Ta
CT
Yeh
Cheng-Nan
CN
Huang
Chao-Ching
CC
Wang
Shih-Min
SM
Liu
Ching-Chuan
CC
Wu
Jing-Ming
JM
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