American Journal of Pediatrics 2019; 5(4): 260-266 http://www.sciencepublishinggroup.com/j/ajp doi: 10.11648/j.ajp.20190504.26 ISSN: 2472-0887 (Print); ISSN: 2472-0909 (Online) Initial Hemodynamic Profiles of Children with Dengue Shock Syndrome in Referral Settings Desy Rusmawatiningtyas 1 , Putu Aditya Wiguna 3 , Intan Fatah Kumara 1 , Nurnaningsih 1 , Saptadi Yuliarto 2 , Eggi Arguni 1 , Antonius Pudjiadi 4, * , Sutaryo 1 1 Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia 2 Departement of Child Health, Faculty of Medicine, Universitas Brawijaya, DR. Saipul Anwar General Hospital, Malang, Indonesia 3 Academic Hospital-Universitas Mataram, Mataram, Indonesia 4 Departement of Child Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia Email address: * Corresponding author 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 Received: October 16, 2019; Accepted: November 8, 2019; Published: November 19, 2019 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 1. Introduction 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 million
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American Journal of Pediatrics 2019; 5(4): 260-266
http://www.sciencepublishinggroup.com/j/ajp
doi: 10.11648/j.ajp.20190504.26
ISSN: 2472-0887 (Print); ISSN: 2472-0909 (Online)
Initial Hemodynamic Profiles of Children with Dengue Shock Syndrome in Referral Settings
Desy Rusmawatiningtyas1, Putu Aditya Wiguna
3, Intan Fatah Kumara
1, Nurnaningsih
1,
Saptadi Yuliarto2, Eggi Arguni
1, Antonius Pudjiadi
4, *, Sutaryo
1
1Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia 2Departement of Child Health, Faculty of Medicine, Universitas Brawijaya, DR. Saipul Anwar General Hospital, Malang, Indonesia 3Academic Hospital-Universitas Mataram, Mataram, Indonesia 4Departement of Child Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Email address:
*Corresponding author
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
Received: October 16, 2019; Accepted: November 8, 2019; Published: November 19, 2019
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.
monitoring of the pathophysiological processes as well as the
preload, contractility and afterload assessment during the
critical course of a dengue infection. Providing physicians
such clinical information will help improve the efficacy of
their treatments and decrease the likelihood of complications
due to dengue shock.
Declaration of Interest
All authors have no competing interest to declare. No
author has any financial association with or received any
funding from USCOM Ltd. or other organizations or
individuals.
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