Treatment of Hand-foot-and-mouth disease with Autonomic Nervous System Dysregulation and Cardiopulmonary Failure

Clinical Scenario

This protocol addresses hand, foot and mouth disease that has progressed to autonomic nervous system (ANS) dysregulation alongside established cardiopulmonary failure — the last and most severe stage of the disease, carrying very poor outcomes.

Presenting Conditions

Beyond ANS dysregulation, this stage is characterised by one or more of: hypotension or shock, pulmonary oedema or pulmonary haemorrhage, or heart failure. The combination of these findings defines the highest-acuity HFMD presentation.

Management Approach (Partial Overview)

Care at this stage centres on mechanical ventilation and judicious intravenous fluid therapy; the complete protocol details the cardiovascular support strategy and any additional measures to be considered.

Instant Access to Structured Evidence-Based Regimens

References

Established cardiopulmonary failure represents the last and most severe stage of the disease and is associated with very poor outcomes.
In addition to evidence of ANS dysregulation, it is characterized by hypotension, shock, pulmonary oedema, pulmonary haemorrhage and heart failure.
Children at this stage invariably require mechanical ventilation and multiple inotropes (milrinone, dobutamine, dopamine, epinephrine).
Judicious intravenous fluid therapy.

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