Clinical efficiency of noninvasive or invasive positive pressure ventilation in treating severe hand foot and mouth disease with pulmonary edema

doi:10.3969/j.issn.1002-1949.2015.08.008

Abstract：Objective To investigate the efficacy of noninvasive or invasive positive pressure ventilation in treatment of severe hand foot and mouth disease ( HFMD ) with pulmonary edema. Methods A total of 228 patients with severe HFMD hospitalized in emergency ward and PICU of Children's Hospital of Jiangxi Province between May 2011 and April 2014 were involved in the present study.The patients were divided into three groups:the control group ( n=70 ) , the CPAP group ( n=108), which on the basis of conventional therapy plus simple nasal continuous positive airway pressure, the ventilation group ( n =50 ) , on the basis of conventional therapy plus invasive mechanical ventilation.Results The total efficiency rate of the stage 2 of CPAP group compared with the control group and ventilation group were not significantly different ( P =0.26, 0.156).The hospitalization duration in the stage 3 of CPAP groups (4.5 ±1.8) days was higher than that of ventilation groups (2.3 ±1.8)days, which were significantly different (P=0.000).The blood glucose (9.8 ±4.1) mmol/L of the stage 3 of ventilation groups was significantly higher than that of CPAP groups [(7.4 ± 2.2)mmol/L, P=0.05].Eight patients in grade 3 of the ventilation group developed to grade 4, these 8 cases were complicated with pulmonary edema, which were (8/40, 20%) significantly higher than those (0/38, 0, P =0.004) of the CPAP group, and 5 cases died of pulmonary hemorrhage, the mortality rate was 62.5%.Therefore the mortality was significantly higher in stage 3 of the ventilation group (5/40, 12.5%) than that of the CPAP group (0/38, 0, P=0.001).Conclusion There is no clinical evidence to recommend use of mechanical ventilation routinely in stage 2 of severe HFMD. Noninvasive positive pressure ventilation may be more advantages in improving symptoms, preventing disease progression, preventing pulmonary edema and reducing the use of invasive ventilation for the stage 3 of severe HFMD.