Volume 5, Issue 4, December 2019, Page: 260-266
Initial Hemodynamic Profiles of Children with Dengue Shock Syndrome in Referral Settings
Desy Rusmawatiningtyas, Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
Putu Aditya Wiguna, Academic Hospital-Universitas Mataram, Mataram, Indonesia
Intan Fatah Kumara, Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
Nurnaningsih, Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
Saptadi Yuliarto, Departement of Child Health, Faculty of Medicine, Universitas Brawijaya, DR. Saipul Anwar General Hospital, Malang, Indonesia
Eggi Arguni, Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
Antonius Pudjiadi, Departement of Child Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Sutaryo, Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
Received: Oct. 16, 2019;       Accepted: Nov. 8, 2019;       Published: Nov. 19, 2019
DOI: 10.11648/j.ajp.20190504.26      View  35      Downloads  15
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.
Keywords
Dengue Shock Syndrome, Initial Hemodynamic Profiles
To cite this article
Desy Rusmawatiningtyas, Putu Aditya Wiguna, Intan Fatah Kumara, Nurnaningsih, Saptadi Yuliarto, Eggi Arguni, Antonius Pudjiadi, Sutaryo, Initial Hemodynamic Profiles of Children with Dengue Shock Syndrome in Referral Settings, American Journal of Pediatrics. Vol. 5, No. 4, 2019, pp. 260-266. doi: 10.11648/j.ajp.20190504.26
Copyright
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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