Restrictive versus Liberal Fluid Resuscitation in Children with Dengue Shock Syndrome: the differences in Clinical Outcomes and Hemodynamic Parameters

Abstract

<strong><em><span style="font-family: Times New Roman;">Background: </span></em></strong><br /> <span style="font-family: Times New Roman;">Fluid resuscitation is the mainstay of treatment to counteract massive plasma leakage in dengue shock syndrome. We aimed to determine the differences in clinical outcomes and hemodynamic parameters of children with dengue shock syndrome post restrictive and liberal fluid resuscitation. </span><br /> <span style="font-family: Times New Roman;"><strong><em>Materials and Methods: </em></strong>A retrospective observational study of pediatric patients who were between one month to 18 years old, presented with clinical criteria for dengue hemorrhagic fever (DHF) grade III and IV based on WHO classification of dengue fever in 2011, and admitted to the Saiful Anwar General Hospital, Malang- Indonesia, from January 2016 to December 2016. Patients were divided in two groups: resuscitated with either 40ml/kg BW (liberal group) solutions; then we analyzed the clinical outcomes and hemodynamic parameters between two groups. </span><br /> <strong><em><span style="font-family: Times New Roman;">Results</span></em></strong><br /> <span style="font-family: Times New Roman;">Among 100 patients, 92 patients were classified as DHF grade III and 8 patients were DHF grade IV. 74 patients were in the restrictive group and 24 patients were in the liberal group. Median age at diagnosis was 6 years old, and 56% of patients were female. No significant differences were observed between length of stay in pediatric intensive care unit (P=0.09), and duration of ventilator use (P=0.68). The restrictive group had 53% lower mortality compared to the liberal group (P=0.18). This study also showed that there were no significant differences in hemodynamic parameters between two groups based on measurement with USCOM which were preload component (SVV) (P=0.89), inotropy components (SMII) (P=0.07), SVRI (P=0.85) as well as the cardiac index (P=0.66).</span><br /> <strong><em><span style="font-family: Times New Roman;">Conclusion</span></em></strong><br /> <span style="font-family: Times New Roman;">This study showed that there is no difference in clinical outcomes (length of mechanical ventilation and length of PICU stay), and hemodynamic parameters (preload, inotropy, afterload, and cardiac index) in Dengue Shock Syndrome patients who receive restrictive or liberal fluid resuscitation.</span>