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Management parameters affecting the outcome of Japanese encephalitis
Serane V Tiroumourougane1, Potula Raghava, S Srinivasana
1Department of Paediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Pondicherry, India. drtmserane@yahoo.com
Insights
Routine sedation and adequate fluid/sodium supplementation improve survival in children with Japanese encephalitis. Conversely, fluid restriction and hyponatremia adversely impact outcomes in pediatric Japanese encephalitis patients.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Japanese encephalitis is a severe neurological disease affecting children.
- Therapeutic strategies vary, impacting patient outcomes.
- Optimizing management is crucial for improving survival rates.
Purpose of the Study:
- To investigate the impact of different therapeutic interventions on survival rates in pediatric Japanese encephalitis patients.
- To identify key factors influencing patient outcomes.
Main Methods:
- A prospective, hospital-based interventional study comparing two treatment protocols (Protocol A and Protocol B).
- Protocol A: fluid restriction, avoidance of routine sedation, higher mannitol doses.
- Protocol B: unrestricted fluids with central venous pressure monitoring, routine sedation, lower mannitol doses, tailored fluid/sodium management based on Glasgow Coma Score (GCS).
Main Results:
- Severe coma (GCS ≤ 8), hyponatremia, fluid restriction, sodium restriction, and shock were independently associated with adverse outcomes.
- Routine use of sedation showed an independent positive association with improved survival (R = -0.393).
Conclusions:
- Sedation should be routinely used in the management of pediatric Japanese encephalitis.
- Adequate fluid and sodium supplementation, individualized to patient needs, are essential for improving survival.
- Avoiding restrictive fluid and sodium strategies is recommended.
Abstract:
The aim of this hospital-based, prospective interventional study was to identify the influence of various therapeutic measures on survival in children with Japanese encephalitis. Fluid restriction, avoidance of routine sedation and higher doses of mannitol were the basis of protocol A (used in the first season). Unrestricted fluid supplementation, guided by central venous pressure monitoring, along with routine sedation and a lower dose of mannitol (only when needed) was used in managing those children with a Glasgow Coma Score (GCS) less than or equal to 8 in the second season. In those children with GCS more than 8, minimal fluid restriction was used and normal sodium supplementation was given. Sedation was given as and when required. The main outcome measure was survival. Severe grades of coma (Spearman rank correlation coefficient [R] = 0.393), hyponatremia (R = 0.658), fluid restriction (R = 0.329), sodium restriction (R = 0.312) and shock (R = 0.659) were found independently to affect the outcome adversely. Use of sedation (R = -0.393) was found to improve the survival independently. It is concluded that sedatives should be routinely used in treatment of children with Japanese encephalitis. Adequate fluids and sodium supplementation tailored to the needs of the patient should be employed in the management of these sick children.