Experience of Sublingual Microcirculation Evaluation in Adults Patients with Severe Dengue

Abstract

BackgroundSevere microcirculatory changes are involved in the pathophysiological mechanisms that lead to irreversible final stages of dengue shock. We report our experience of the evaluation of sublingual microcirculation in adult patients with severe dengueMethodsAdults patients with severe dengue (by WHO 2009 criteria) were included. Dengue diagnostics was made by positive serology for IgM / IgG, antigen NS1 or PCR. Sublingual Microcirculation (SM) was evaluated by Sidestream Dark Field imaging. Microvascular flow index (MFI), proportion of small-perfused vessels (%SVP), heterogeneity index (HI) and Total Vascular Density were calculated. All patients received Fluids Challenge (FC) at hospital admission.ResultsSM was assessed in 10 patients. The median age was 65 years [IQR: 34–70], 60% were male. Eight patients were admitted to the ICU, of which 63% required invasive ventilatory and vasoactive support. One patient died. After the fluid challenge, the median of the %SVP was 94 [IR: 97 – 77], the median of the MFI was 2.82 [IR: 2, 85 – 2, 14]. There were not significant differences in %SVP and MFI among the patients who survived. In the deceased patient, the %SVP with continuous flow was 59, 18% and the MFI was 1, 45; these values were significantly decreased compared with patients who survived. A significant negative correlation between hematocrit and %SVP, and MFI was found.ConclusionInitial fluid challenge, that identifies and treats volume depletion, could correct microcirculation abnormalities evaluated by SDF imaging. However, in the patient who did not respond to this challenge, significant alterations of the MFI and the %SVP were evidenced. There is a need for more studies to improve our understanding of the role of microcirculation evaluation in these patients.Disclosures All authors: No reported disclosures.