Kompleksowe leczenie i opieka pielęgnacyjna u dzieci z zespołem epilepsji związanym z infekcją gorączkową w fazie ostrej: seria przypadków
Multidisciplinary management and nursing care for pediatric patients with febrile infection-related epilepsy syndrome in the acute phase: A case series
W skrócie
Artykuł opisuje leczenie trzech chłopców w wieku 5-10 lat, u których rozwinął się rzadki zespół epilepsji FIRES - choroba rozpoczynająca się nagłymi drgawkami i gorączką. Wszyscy pacjenci wymagali leczenia na oddziale intensywnej opieki medycznej, respiratora, leków przeciwdrgawkowych i specjalnej diety. Dzięki współpracy wielu specjalistów oraz długotrwałej pielęgnacyjnej opiece wszyscy pacjenci przeżyli, choć ich powrót do zdrowia przebiegał różnie - od pełnego wyzdrowienia do wsparcia respiratora w domu.
Oryginalny abstract (angielski)
RATIONALE: This case series discusses the nursing care and clinical outcomes of 3 pediatric patients with febrile infection-related epilepsy syndrome (FIRES) and acute-phase complications, focusing on critical care interventions such as seizure management, respiratory support, and nutritional therapy. PATIENT CONCERNS: Three male patients, aged 10, 5, and 7, presented with altered consciousness, seizures, and recurrent fever. Diagnostic tests, including magnetic resonance imaging, electroencephalogram (EEG), and cerebrospinal fluid analysis, revealed abnormal EEG findings, suspected meningeal inflammation, and cerebrospinal fluid abnormalities. DIAGNOSES: All patients were diagnosed with FIRES, accompanied by acute neurological deterioration, supported by EEG and magnetic resonance imaging. INTERVENTIONS: All patients required intensive care unit mechanical ventilation. Two underwent tracheostomy during prolonged ventilator dependence, whereas 1 was extubated to low-flow nasal oxygen after approximately 14 days without tracheostomy. Seizure management included anticonvulsants and a ketogenic diet, with individualized adjustments according to clinical response. Multidisciplinary care involved specialists in neurology, respiratory medicine, and rehabilitation. OUTCOMES: Short-term outcomes differed. One tracheostomized patient was later decannulated and discharged clinically improved, with recovery of communication, oral intake, and independent ambulation. The non-tracheostomized patient remained off invasive ventilation but continued inpatient neurologic and nutritional management, while the other tracheostomized patient still required ventilatory and neurologic management in the latest available record. LESSONS: Coordinated multidisciplinary nursing, early nutritional planning, and structured monitoring may help organize acute-phase FIRES care while supporting individualized respiratory, seizure, and complication management.