Management parameters affecting the outcome of Japanese encephalitis

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.