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Initial Hemodynamic Profiles of Children with Dengue Shock Syndrome in Referral Settings

Received: 16 October 2019     Accepted: 8 November 2019     Published: 19 November 2019
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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.

Published in American Journal of Pediatrics (Volume 5, Issue 4)
DOI 10.11648/j.ajp.20190504.26
Page(s) 260-266
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Dengue Shock Syndrome, Initial Hemodynamic Profiles

References
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  • APA Style

    Desy Rusmawatiningtyas, Putu Aditya Wiguna, Intan Fatah Kumara, Nurnaningsih, Saptadi Yuliarto, et al. (2019). Initial Hemodynamic Profiles of Children with Dengue Shock Syndrome in Referral Settings. American Journal of Pediatrics, 5(4), 260-266. https://doi.org/10.11648/j.ajp.20190504.26

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    ACS Style

    Desy Rusmawatiningtyas; Putu Aditya Wiguna; Intan Fatah Kumara; Nurnaningsih; Saptadi Yuliarto, et al. Initial Hemodynamic Profiles of Children with Dengue Shock Syndrome in Referral Settings. Am. J. Pediatr. 2019, 5(4), 260-266. doi: 10.11648/j.ajp.20190504.26

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    AMA Style

    Desy Rusmawatiningtyas, Putu Aditya Wiguna, Intan Fatah Kumara, Nurnaningsih, Saptadi Yuliarto, et al. Initial Hemodynamic Profiles of Children with Dengue Shock Syndrome in Referral Settings. Am J Pediatr. 2019;5(4):260-266. doi: 10.11648/j.ajp.20190504.26

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  • @article{10.11648/j.ajp.20190504.26,
      author = {Desy Rusmawatiningtyas and Putu Aditya Wiguna and Intan Fatah Kumara and Nurnaningsih and Saptadi Yuliarto and Eggi Arguni and Antonius Pudjiadi and Sutaryo},
      title = {Initial Hemodynamic Profiles of Children with Dengue Shock Syndrome in Referral Settings},
      journal = {American Journal of Pediatrics},
      volume = {5},
      number = {4},
      pages = {260-266},
      doi = {10.11648/j.ajp.20190504.26},
      url = {https://doi.org/10.11648/j.ajp.20190504.26},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20190504.26},
      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.},
     year = {2019}
    }
    

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  • TY  - JOUR
    T1  - Initial Hemodynamic Profiles of Children with Dengue Shock Syndrome in Referral Settings
    AU  - Desy Rusmawatiningtyas
    AU  - Putu Aditya Wiguna
    AU  - Intan Fatah Kumara
    AU  - Nurnaningsih
    AU  - Saptadi Yuliarto
    AU  - Eggi Arguni
    AU  - Antonius Pudjiadi
    AU  - Sutaryo
    Y1  - 2019/11/19
    PY  - 2019
    N1  - https://doi.org/10.11648/j.ajp.20190504.26
    DO  - 10.11648/j.ajp.20190504.26
    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
    SP  - 260
    EP  - 266
    PB  - Science Publishing Group
    SN  - 2472-0909
    UR  - https://doi.org/10.11648/j.ajp.20190504.26
    AB  - 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.
    VL  - 5
    IS  - 4
    ER  - 

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Author Information
  • Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

  • Academic Hospital-Universitas Mataram, Mataram, Indonesia

  • Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

  • Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

  • Departement of Child Health, Faculty of Medicine, Universitas Brawijaya, DR. Saipul Anwar General Hospital, Malang, Indonesia

  • Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

  • Departement of Child Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

  • Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

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