Abstract
Background: Fluid therapy for dengue shock syndrome (DSS) requires a dynamic approach that involves monitoring of the pathophysiological processes as well as the preload, contractility, and afterload assessment during the course dengue infection. Hemodynamically unstable DSS patients received in referral setting often complicated by fluid overload and secondary infection. Objective: This study aims to provide hemodynamic profiles and fluid responsiveness of pediatric patients admitted to the PICU with DSS. Methods: Hemodynamic profiles, laboratories, and demographic data were collected from patients aged 1 month to 18 years old with DSS who were admitted to the Pediatric Intensive Care Unit (PICU) at Dr. Sardjito General Hospital, Yogyakarta, Indonesia from January to December 2016. Hemodynamic profiles were assessed in clinically shock and not clinically shock group at PICU admission using the non-invasive Ultrasonic Cardiac Output Monitor (USCOM). Fluid responsiveness in clinically shock group was evaluated after fluid challenge with 10 ml/kgBW crystalloid or colloid. Results: Eighty six subjects were included in this study. Sixty six subjects were admitted to PICU with clinically shock condition. This group received less intravenous fluid than hemodynamically stable group (6.9 vs 7.52 ml/kgBW/hour respectively), had higher mean hematocrit level (42.09% vs 40.32% respectively), had higher hematocrit level during PICU stay (43.37% vs 42.06% respectively), significantly higher percentage to receive inotropes agent (62,1% vs 5%, p 0,000) and longer duration of inotropes usage (23,5 vs 0 hours, p 0.72). From the clinically shock patients admitted to PICU, only 19,69% were fluid responsive. Other subjects in this group with fluid non responsive state, 90,38% had low inotropic index and high systemic vascular resistance index. Among 8 patients in clinically shock group who died during PICU stay, 6 of them had low cardiac Index, fluid non responsive condition, low inotropic index and high systemic vascular resistance index. Conclusion: Only a small percentage of DSS patients with clinically shock admitted to the PICU were fluid responsive. Majority of DSS cases in children had low inotropy index and high systemic vascular resistance index.
Highlights
Dengue shock syndrome (DSS) has been the most common diagnosis of patient admitted to the pediatric intensive care unit (PICU) for the last 2 consecutive years (2015-2016)
This study found that in group 1, patients had received less intravenous fluid prior to their admissions to the Pediatric Intensive Care Unit (PICU) compared to group 2 patients (6.90 vs. 7.52 ml/kgBW/hour)
Group 1 patients were characterized by higher mean hematocrit level upon PICU arrival (42.09% vs. 40.32%) and higher value of the highest hematocrit level reached during the PICU stay (43.37% vs. 42.06%)
Summary
Dengue shock syndrome (DSS) has been the most common diagnosis of patient admitted to the pediatric intensive care unit (PICU) for the last 2 consecutive years (2015-2016). [1] The number of dengue cases reported annually to World Health Organization (WHO) had continued to increase from 0.4 million in 1996 to 1.3 million261 Desy Rusmawatiningtyas et al.: Initial Hemodynamic Profiles of Children with Dengue Shock Syndrome in Referral Settings in 2005, 2.2 million in 2010, and 3.2 million in 2015. [2] In 2013, dengue was estimated to be responsible for approximately 3.2 million severe cases and 9000 deaths, the majority of which occurred in lower middle-income countries. [3, 4]The WHO has issued a guideline for DSS management. Dengue shock syndrome (DSS) has been the most common diagnosis of patient admitted to the pediatric intensive care unit (PICU) for the last 2 consecutive years (2015-2016). Objective: This study aims to provide hemodynamic profiles and fluid responsiveness of pediatric patients admitted to the PICU with DSS. From the clinically shock patients admitted to PICU, only 19,69% were fluid responsive Other subjects in this group with fluid non responsive state, 90,38% had low inotropic index and high systemic vascular resistance index. Among 8 patients in clinically shock group who died during PICU stay, 6 of them had low cardiac Index, fluid non responsive condition, low inotropic index and high systemic vascular resistance index. Majority of DSS cases in children had low inotropy index and high systemic vascular resistance index
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