Pr FAKHR Kawtar Encéphalites aiguës graves & réanimation

This presentation by Pr FAKHR Kawtar focuses on severe acute encephalitis in pediatric intensive care. It begins by highlighting the incidence (10-14 per 100,000 children) and the importance of early recognition by frontline healthcare professionals. The speaker defines encephalitis as inflammation of the brain parenchyma with neurological dysfunction, distinguishing it from encephalopathy. Etiologies have shifted from primarily infectious to include autoimmune and dysimmune causes, which are increasingly recognized but often delayed in diagnosis. The presentation outlines diagnostic criteria based on the French Society of Anesthesia and Intensive Care (SFAR) and international consensus, including a major criterion (altered consciousness) and minor criteria (fever, seizures, focal deficits, CSF pleocytosis, neuroimaging abnormalities). Indications for transfer to the ICU are discussed, including organ failure such as neurological (GCS <13), respiratory, or hemodynamic instability. The Glasgow Coma Scale is adapted for pediatric age groups. Management is divided into immediate intervention and ongoing etiological evaluation. Immediate goals include supporting vital functions (ABC), treating life-threatening causes like intracranial hypertension, and controlling seizures. The speaker details airway management, including intubation criteria (GCS <8, drop of 3 points, signs of herniation), and cautions against aggressive hyperventilation due to risk of cerebral ischemia. Hemodynamic support includes fluid resuscitation and vasoactive drugs to maintain cerebral perfusion pressure. The physiology of cerebral autoregulation is explained, emphasizing that children have higher cerebral blood flow requirements. Target mean arterial pressure varies by age, and intracranial pressure monitoring is essential, with treatment including osmotherapy (hypertonic saline, mannitol). Seizure management follows a three-line approach: benzodiazepines, then phenytoin or midazolam, then anesthetic drugs for refractory status epilepticus. The presentation concludes with monitoring techniques such as transcranial Doppler, continuous EEG, and NIRS.