Abstract P-159: SEVERE DENGUE IN THE PICU: A SINGLE CENTRE EXPERIENCE

Abstract

Aims & Objectives: The prevalence of severe dengue in children is lower than in adults; but is associated with higher mortality. We present the clinical features and outcomes of children with severe dengue infection. Methods Medical records of children admitted to the Paediatric Intensive Care Unit (PICU) of a tertiary hospital for severe dengue, from 1 January 2015 to 31 December 2016, were retrospectively analysed for demographic data, haemodynamic parameters on admission, inotropes used, length of PICU stay and outcomes. Paediatric Index of Mortality 2 (PIM2) and Paediatric Logistic Organ Dysfunction 2 (PELOD2) scores were used to assess the severity of these patients. Results Thirteen patients with serologically confirmed severe dengue (shock ± hypotension) were admitted during the study period. Seven patients (54%) presented with hypotension. The majority of patients (85%) had a serum lactate level more than 2 mmol/L on admission. All patients required at least 20 mL/kg of fluid boluses. Inotropes were initiated in 9 patients (69%) for poor perfusion despite after fluid boluses of >20mL/kg. Two (15.4%) patients (Patient 8 and 9) died due to decompensated shock. Both patients had PIM2 scores of >10, required large amounts of fluid boluses during resuscitation (50ml/kg) and had refractory hypotension (Table 1). All patients who survived had improvements in the lactate levels.Conclusions Management of severe dengue in children is challenging as it involves a fine balance of fluid therapy. More studies are required to better understand the haemodynamic changes and myocardial dysfunction in severe dengue and the role of inotropes in managing these patients.