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  527      Downloads  112
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.
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 © 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.
Patient register annual data report Dr. Sardjito General Hospital 2017. Yogyakarta, Indonesia. 2017.
World Health Organization. Global Strategy for Dengue Prevention and Control 2012–2020. World Health Organ. 2012; 43.
Stanaway JD, Shepard DS, Undurraga EA, Halasa YA, Coffeng LE, Brady OJ, et al. The global burden of dengue: an analysis from the Global Burden of Disease Study 2013. Lancet Infect Dis. 2016; 16: 712–23.
World Health Organization. Dengue: guidelines for diagnosis, treatment, prevention, and control. Spec Program Res Train Trop Dis. 2009; 43.
Alobaidi R, Morgan C, Basu RK, Stenson E, Feartherstone R, Majumdar SR, et al. Association between fluid balance and outcome in Critically ill children: A systematic review and meta-analysis. JAMA Pediatr. 2018.
Chand R, Mehta Y, Trehan N. Cardiac output estimation with a new doppler device after off-pump coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 2006; 20 (3): 315–9.
Phillips R, Paradisis M, Evans N, Southwell D, Burstow D, West M. Cardiac output measurement in preterm neonates: validation of USCOM against echocardiography [abstract]. Crit Care. 2006; 10 (1 suppl): p343
Chew MS, Poelaert J. Accuracy and repeatability of pediatric cardiac output measurement using Doppler: 20-year review of the literature. Intensive Care Med. 2003; 29: 1889–94.
Dhanani S, Barrowman NJ, Ward RE, Murto KT. Intra- and inter-observer reliability using a noninvasive ultrasound cardiac output monitor in healthy anesthetized children. Pediatr Anesth. 2011; 21: 858–64.
Cattermole GN, Leung PYM, Mak PSK, Chan SSW, Graham CA, Rainer TH. The normal ranges of cardiovascular parameters in children measured using the Ultrasonic Cardiac Output Monitor. Crit Care Med. 2010; 38: 1875–81.
Kuster M, Exadaktylos A, Schnuriger B. Non-Invasive hemodynamic monitoring in trauma patients. World J Emerg Surg. 2015; 10: 11.
Madigan VM, Smith BE. Non-invasive method for rapid bedside estimation of inotropy: Theory and preliminary clinical validation. Br J Anaesth. 2013; 111: 580–8.
Dinh The T, Le Thi Thu T, Nguyen Minh D, Tran Van N, Tran Tinh H, Nguyen Van Vinh C, et al. Clinical Features of Dengue in a Large Vietnamese Cohort: Intrinsically Lower Platelet Counts and Greater Risk for Bleeding in Adults than Children. Halstead SB, editor. PLoS Negl Trop Dis. 2012; 6: e1679.
Rajapakse S, Rodrigo C, Rajapakse A. Treatment of dengue fever. Infect Drug Resist. 2012; 5: 103–12.
Thanachartwet V, Wattanathum A, Sahassananda D, Wacharasint P, Chamnanchanunt S, Khine Kyaw E, et al. Dynamic Measurement of Hemodynamic Parameters and Cardiac Preload in Adults with Dengue: A Prospective Observational Study. Huy NT, editor. PLoS One. 2016; 11: e0156135.
Moulton SL, Mulligan J, Srikiatkhachorn A, Kalayanarooj S, Grudic GZ, Green S, et al. State-of-the-art monitoring in treatment of dengue shock syndrome: a case series. J Med Case Rep. 2016; 10: 233.
Li C, Lin F, Fu S, Chen G, Yang X, Zhu C, and others. Stroke volume variation for prediction of fluid responsiveness in patients undergoing gastrointestinal surgery. Int J Med Sci. 2013; 10 (2): 148-55.
Critchley L, Peng Z, Fok B. Testing the reliability of a new ultrasonic cardiac output monitor, the USCOM, by using aortic flow probes in anesthetized dogs. Anesth Analg. 2005; 100 (3): 748–53.
Vincent JL, Weil MH. Fluid challenge revisited. Crit Care Med. 2006; 34: 1333–7.
Muller L, Toumi M, Bousquet PJ, Riu-Poulenc B, Louart G, Candela D, et al. An increase in aortic blood flow after an infusion of 100 ml colloid over 1 minute can predict fluid responsiveness: the mini-fluid challenge study. Anesthesiology. 2011; 115: 541–7.
Monnet X, Marik PE, Teboul JL. Prediction of fluid responsiveness: an update. Annals of intensive care. 2016; 6: 111-118.
Nixon J, Murray R, Leonard P, Al. E. Effect of large variations in preload on left ventricular performance characteristics in normal subjects. Circulation. 1982; 65: 698–703.
Arikan AA, Citak A. Pediatric shock. Signa Vitae. 2008; 3: 13–23.
Convertino VA, Wirt MD, Glenn JF, Lein BC. The compensatory reserve for early and accurate prediction of hemodynamic compromise: A review of the underlying physiology. Shock. 2016; 45: 580–90.
Khongphatthanayothin A, Lertsapcharoen P, Supachokchaiwattana P, La-orkhun V, Khumtonvong A, Boonlarptaveechoke C, et al. Myocardial depression in dengue hemorrhagic fever: Prevalence and clinical description. Pediatr Crit Care Med. 2007; 8: 524–9.
Kirawittaya T, Yoon IK, Wichit S, Green S, Ennis FA, Gibbons R V., et al. Evaluation of cardiac involvement in children with dengue by serial echocardiographic studies. PLoS Negl Trop Dis. 2015; 9: 1–17.
Teparrukkul P, Hantrakun V, Day NPJ, West TE, Limmathurotsakul D. Management and outcomes of severe dengue patients presenting with sepsis in a tropical country. PLoS One. 2017; 12: 1–13.
Virk HUH, Inayat F, Ur Rahman Z. Complete heart block in association with dengue hemorrhagic fever. Korean Circ J. 2016; 46: 866–9.
Wongsa A. Fluid and hemodynamic management in severe dengue. Southeast Asian J Trop Med Public Health. 2015; 46: 123–7.
Beltramo F, Menteer J, Razavi A, Khemani RG, Szmuszkovicz J, Newth CJL, et al. Validation of an Ultrasound Cardiac Output Monitor as a Bedside Tool for Pediatric Patients. Pediatr Cardiol. 2016; 37: 177–83.
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