Abstract
BackgroundHand, foot and mouth disease (HFMD) remains a burdensome health issue in mainland China. Enterovirus71 (EV-A71) is the main pathogen of severe HFMD. Continuous hemofiltration improves fluid overload, restores kidney function and alleviates inflammatory reactions. The aim of the present study was to evaluate the effects of continuous veno-venous hemodiafiltration (CVVHDF) on severe HFMD caused by EV-A71(EV-A71-HFMD) in a pediatric intensive care unit (PICU).MethodsA retrospective observational study was performed in a tertiary university PICU from January 2012 to December 2016. Children with severe EV-A71-HFMD complicated by cardiopulmonary failure were included. The patients were divided into a CVVHDF group and a conventional therapy (control) group (non-CVVHDF). The demographics, characteristics, and outcomes between the groups were collected and analyzed.ResultsTwenty-nine patients with severe EV-A71-HFMD were enrolled. The 28-day mortality was 17.6% (3/17) in the CVVHDF group and 33.3% (4/12) in the non-CVVHDF group, with no statistical significance between the two groups (P = 0.403). The median interval between CVVHDF initiation and PICU admission was 6 (4,8.5) hrs, and the median duration of CVVHDF was 48 (36, 64) hrs. The left ventricular ejection fraction (LVEF) and cardiac index (CI) in the CVVHDF group were improved after treatment. The plasma levels of catecholamines and renin-angiotensin-aldosterone system (RAAS) substances in the CVVHDF group were significantly decreased after treatment. The decreased catecholamines and RAAS substances included adrenalin (169.8 [145.5, 244.6] vs. 148.0 [109.0, 208.1] ng/L, P = 0.033), dopamine (152.7 [97.0, 191.1] vs. 96.0 [68.0, 160.9] ng/L, P = 0.026), angiotensin II (185.9 [125.2, 800.0] vs. 106.0 [90.8, 232.5] ng/L, P = 0.047), aldosterone (165.7 [94.0, 353.3] vs. 103.3 [84.3, 144.3] ng/L, P = 0.033), and renin (1.12 [0.74, 3.45] vs. 0.79 [0.52, 1.25] μg/L/h, P = 0.029),ConclusionsCVVHDF reduced the levels of catecholamines and RAAS substances and improved cardiovascular function. Continuous hemodiafiltration may represent a potential therapy in patients with severe EV-A71-HFMD complicated with cardiopulmonary failure.
Highlights
Hand, foot and mouth disease (HFMD) remains a burdensome health issue in mainland China
Hand, foot and mouth disease (HFMD) has become a major global health issue, and HFMD in China accounted for 87% (9.8 million/11.3 million) of all HFMD cases reported to the World Health Organization (WHO) from 2010 to 2014 [1]
There was no significant difference in age, sex, body weight, temperature, heart rate, blood pressure, left ventricular ejection fraction (LVEF), cardiac index (CI) or the use of vasoactive agents between the non-continuous veno-venous hemodiafiltration (CVVHDF) group and the CVVHDF group
Summary
Foot and mouth disease (HFMD) remains a burdensome health issue in mainland China. The aim of the present study was to evaluate the effects of continuous veno-venous hemodiafiltration (CVVHDF) on severe HFMD caused by EV-A71(EV-A71-HFMD) in a pediatric intensive care unit (PICU). According to the China Guidelines for the diagnosis and treatment of severe HFMD due to EV-A71 [4], severe HFMD with cardiopulmonary failure caused by EV-A71, referred to as stage 3–4 EV-A71-HFMD, remains a lifethreatening and challenging disease in a pediatric intensive care units (PICUs) in China. Limited studies have observed that hemofiltration is be an efficient rescue treatment in children with severe HFMD [9,10,11].CRRT has been empirically used in patients with severe EV-A71-HFMD with cardiopulmonary failure since 2012 in our PICU. We suspected that hemofiltration could be a potential therapy for severe EV-A71HFMD complicated by cardiopulmonary failure
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
