Children with symptoms of a disease, average and heavy symptoms need to be hospitalized. Extent of leaving is defined by disease severity. To the children's intensive care care unit hospitalize children with the unstable hemodynamics (shock, arrhythmia) expressed by respiratory insufficiency, or other life-threatening states. In the available series of cases, most of patients needed assistance in intensive care unit. It is expedient to treat patients with easy forms in out-patient conditions. However there is a risk of progressing of a disease from easy to average degree, and then - to heavy therefore it is recommended to hospitalize patients in whom the high level of inflammatory markers is found.
For children who are on out-patient treatment it is important to explain conditions under which the address to the doctor is necessary and to provide the corresponding medical observation. In the presence of constant fever children have to be under observation within 48 hours. The subsequent observation has to include clinical assessment and repeated carrying out laboratory researches.
By definition, the multisystem inflammatory syndrome (MIS) at children is a polygeneral disease and care of patients demands collaboration of several specialists, such as children's infectious diseases specialists, children's rheumatologists, children's cardiologists, children's resuscitators, children's hematologists.
MVS at children can have the signs and symptoms imitating septic and toxic shock. Thus, patients have an expressed multisystem defeat. At shock immediate purpose of therapy by antibiotics of a broad spectrum of activity before obtaining results of sensitivity to ABP is recommended. According to the data which are available today empirical purpose of a tseftriakson in combination with Vancomycinum is recommended. The scheme tseftarolin + piperatsillin + to tazobakta is an alternative method of treatment, especially for children with an acute renal failure. Clindamycin is added to schemes at emergence of the symptoms mediated by effect of toxins of bacteria (for example, an erythrosis). Reception of antibiotics should be stopped after an exception of a bacterial infection if the clinical status of the child was stabilized.
The role of antiviral therapy at SARS-CoV-2 (for example, remdesiviry) in treatment of MVS at children is not defined. Many patients have a polymerase chain reaction (PCR) dat a negative take on SARS-CoV-2. As we discussed earlier, MVS at children most likely is a postinfectious complication, but not an active infection, however, some children at a positive take of testing of PTsR can have the current infection. Thus, at some patients antiviral therapy can have an impact on process of a disease. Use of antiviral drugs is usually recommended for children with heavy manifestations of MVS.
Additional therapy depends on a clinical picture of a disease. For example, patients with a syndrome of Kawasaki with "warm shock" have to receive the corresponding treatment and also necessary hemodynamic support.
Children with manifestations of shock need to be conducted according to standard protocols. In an available series of cases most of children with MVS had "a warm shock" which is badly susceptible to treatment by infusional therapy. Adrenaline is preferred by many as vascular drug for management of warm shock. At children with the expressed dysfunction of a ventricle purpose of a milrinon is shown.
During an acute inflammatory phase at children with myocardium dysfunction, arrhythmia and hemodynamic disturbances can be observed. Periodic carrying out an echocardiography of heart and control of the level of natriuretic peptide and a troponin can help with performing therapy. Maintaining such patients has to be concentrated on a maintenance therapy for maintaining hemodynamic stability and ensuring adequate systematic perfusion. In cases of a lightning course of a disease, mechanical hemodynamic support in a type of extracorporal membrane oxygenation (EKMO) or devices for support of work of ventricles can be required.
Patients with MVS at children are subject to risk of emergence of trombotichesky complications. All patients who correspond to criteria for a full or incomplete syndrome of Kawasaki have to receive antitrombotichesky therapy, and if necessary additional anticoagulating therapy.