SEVERE COMPLICATIONS OF MEASLES REQUIRING INTENSIVE-CARE IN INFANTS AND YOUNG-CHILDREN

Objective: To evaluate the characteristics of severe complications of measles in patients admitted to a pediatric intensive care unit. Desig n: Clinical description of a case series. Setting: The Pediatric Inten sive Care Unit of Soroka Medical Center, Beer-Sheva, Israel, during a measles epidemic. Patients: Fifteen pediatric patients with measles re quiring intensive care. Results: Fifteen of 237 hospitalized children with measles required intensive care in the Pediatric Intensive Care U nit. Eleven patients were malnourished; none had been vaccinated for m easles. All 15 patients required mechanical ventilation for pneumonia that had caused severe respiratory distress. Twelve of 15 patients wer e severely hypoxemic before intubation. Seven had a clinical syndrome consistent with adult respiratory distress syndrome. Other complicatio ns on admission to the intensive care unit included spontaneous pneumo thorax in three patients, empyema in two, encephalopathy in seven, sho ck in three, sepsis in five, hypocalcemia in 11, thrombocytopenia in e ight, and coagulopathy in seven. Complications during treatment includ ed pneumothorax in four patients, fibrosing alveolitis in one, brain i nfarct in one, thrombus formation in three, and nosocomial sepsis in o ne. Four patients had long-term sequelae (chronic lung disease, subacu te sclerosing panencephalitis, hemiplegia, and partial amputation of a limb), and seven patients recovered uneventfully. Four patients died; all had adult respiratory distress syndrome, three had pneumothorax, and one had nosocomial sepsis. Conclusions: Patients with measles who require intensive care have a high risk for death or long-term complic ations, even when treated in a modern pediatric intensive care unit. A dult respiratory distress syndrome and air leaks were the most severe complications in these patients. To reduce the severity of these compl ications, mechanical ventilation should be based on using the lowest p ossible inspiratory pressure and fraction of inspired oxygen, while ac cepting an arterial oxygen pressure less than 60 mm Hg. Secondary bact eremia was an early and prominent complication, and antibiotic treatme nt should be instituted early in patients with measles requiring inten sive care.