Diagnosis and treatment of 64 children with viral encephalitis complicated with respiratory failure

Objective To summarize the clinical features of children with viral encephalitis accompanied with respiratory failure, and to improve the early diagnosis and treatment. Methods The clinical data of 64 cases with viral encephalitis combined with respiratory failure in our unit from May 2005 to May 2015 were analyzed retrospectively. Results All children were characterized by sudden onset.Among them, 60 cases(93.7%) had fever, 50 cases(78.1%) had convulsion onset, 46 cases(71.8%) had consciousness disorders, 30 cases(46.8%) had positive pathological signs.Most of them developed respiratory failure in acute stage.Total 56 cases occurred central respiratory failure, 6 cases occurred central respiratory failure with peripheral respiratory failure, 2 cases occurred respiratory and circulatory failure.Total 46 cases underwent cerebrospinal fluid examination.Routine biochemical test found 32 abnormal cases, of which 10 cases had intracranial hypertension and 19 cases had leukocytosis, and 17 cases had increased protein content.Ten cases were positive in cerebrospinal fluid etiology examination, including herpes simplex virus positive in 8 cases, EB virus positive in 1 case, and coxsackie virus positive in 1 case.There were 6 of 64 cases with abnormal CT scans and 29 of 34 cases with abnormal MRI.The results of EEG examination were abnormal in all patients for the first time.The EEG of 48 cases showed diffuse slow waves-δ activity.EEG examination showed generalized discharges or focal discharges during treatment in 22 cases.Five cases of electrophysiological examination showed cervical spinal cord anterior horn injury.Total 24 cases were complicated with stress ulcer, 4 cases with liver damage, 6 cases with heart damage, 4 cases with renal damage, 1 case with lung damage.All cases underwent mechanical ventilation for 2-50 days.Total 33 cases(51.5%) improved and discharged, 14 cases died during hospitalization, 17 cases were given up treatment.Total 25 cases had variety of neurological dysfunctions left.Total 14 cases with epilepsy were followed up for 3 months to 6 years in our department, of which 8 cases were medically intractable epilepsies. Conclusion The children with viral encephalitis complicated with respiratory failure have acute onset, rapid progress, high disability and mortality.Early diagnosis and evaluation, effective mechanical ventilation in time, and protecting organ function, help to improve the prognosis. Key words: Viral encephalitis; Respiratory failure; Mechanical ventilation; Children