Pediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), and Université de Paris, Paris, France.
Pediatric Neurology Unit, Robert-Debré University Hospital, AP-HP, and Université de Paris, Paris, France.
Pediatr Crit Care Med. 2021 Nov 1;22(11):e582-e587. doi: 10.1097/PCC.0000000000002750.
To describe and estimate the mortality rate of severe influenza-associated encephalopathy/encephalitis among children admitted to PICUs.
Multicenter retrospective study.
Twelve French PICUs.
All children admitted for influenza-associated encephalopathy/encephalitis between 2010 and 2018 with no severe preexisting chronic neurologic disorders and no coinfection potentially responsible for the disease.
None.
We collected the clinical presentation; laboratory, electroencephalographic, and MRI findings; and treatments used in the PICU. The primary outcome was mortality. The secondary outcomes included sequelae at discharge and last follow-up. We included 41 patients with a median (interquartile range) age of 4.7 years (2.5-8.2 yr). The main reasons for admission were altered consciousness (59%) and status epilepticus (34%); 48% of patients had meningitis, and one third had acute necrotizing encephalopathy on MRI. Mechanical ventilation was required in 73% of patients and hemodynamic support in 24%. The use of specific treatments was variable; steroids were given to 49% of patients. Seven patients (17%) died in the PICU. Median (interquartile range) PICU stay length was 7 days (2-13 d), and total hospital length of stay was 23 days (7-33 d). On hospital discharge, 49% (n = 20) had neurologic sequelae, with 27% (n = 11) having severe disabilities defined by modified Rankin Score greater than or equal to 4.
Children requiring PICU admission for influenza-associated encephalopathy/encephalitis have high mortality and morbidity rates. The management remains highly variable due to the lack of guidelines.
描述并估计因流感相关脑炎/脑炎入住儿科重症监护病房（PICU）的患儿的死亡率。
多中心回顾性研究。
法国 12 个 PICU。
2010 年至 2018 年间，所有因流感相关脑炎/脑炎入住且无严重既往慢性神经障碍、无潜在可导致疾病的合并感染的患儿。
无。
我们收集了患儿的临床表现、实验室、脑电图和 MRI 检查结果以及在 PICU 中的治疗措施。主要结局为死亡率。次要结局包括出院和最后随访时的后遗症。共纳入 41 例患儿，中位（四分位距）年龄为 4.7 岁（2.5-8.2 岁）。主要入院原因包括意识改变（59%）和癫痫持续状态（34%）；48%的患儿有脑膜炎，三分之一的患儿 MRI 检查有急性坏死性脑病。73%的患儿需要机械通气，24%的患儿需要血流动力学支持。具体治疗方法的使用各不相同；49%的患儿使用了类固醇。7 例（17%）患儿在 PICU 死亡。中位（四分位距）PICU 住院时间为 7 天（2-13 天），总住院时间为 23 天（7-33 天）。出院时，49%（n=20）的患儿有神经后遗症，27%（n=11）的患儿因改良 Rankin 评分≥4 定义为严重残疾。
因流感相关脑炎/脑炎入住 PICU 的患儿死亡率和发病率均较高。由于缺乏指南，管理方法仍然差异很大。
