Targeted Interventions in Critically Ill Children with Severe Dengue

Abstract

Background:The World Health Organization guidelines provide suggestions on early recognition and treatment of severe dengue (SD); however, mortality in this group can be high and is related both to disease severity and the treatment complications.Subjects and Methods:In this prospective observational study, we report our results where standard therapy (ST) was enhanced by Intensive Care Unit (ICU) supportive measures that have proven beneficial in other conditions that share similar pathophysiology of capillary leak and fluid overload. These include early albumin for crystalloid-refractory shock, proactive monitoring for symptomatic abdominal compartment syndrome (ACS), application of a high-risk intubation management protocol, and other therapies. We compared outcomes in a matched retrospective cohort who received ST.Results:We found improved outcomes using these interventions in patients with the most devastating forms of dengue (ST+ group). We could demonstrate decreased positive fluid balance on days 1–3 and less symptomatic ACS that necessitated invasive percutaneous drainage (7.7% in ST+ group vs. 30% in ST group, P = 0.025). Other benefits in ST+ group included lower intubation and positive pressure ventilation requirements (18.4% in ST+ vs. 53.3% in ST, P = 0.003), lower incidence of major hemorrhage and acute kidney injury, and reduced pediatric ICU stays and mortality (2.6% in ST+ group vs. 26% in ST group, P = 0.004).Conclusion:Children with SD with refractory shock are at extremely high mortality risk. We describe the proactive application of several targeted ICU supportive interventions in addition to ST and could show that these interventions resulted in decreased resuscitation morbidity and improved outcomes in SD.

Hyperferritinemia in Severe Dengue Infection: Single-Center Retrospective Cohort Study

“…The key to good outcomes in sd may be standard supportive care, including early recognition and meticulously titrated restoration of the circulation with IV fluids and blood transfusion when necessary (4, 7). Extensive immune activation is a hallmark of sd (1), and we identified a relationship between 2009 WHO categories for sd and ferritin level on day 1 of PICU admission and could demonstrate higher ferritin levels with incremental involvement of sd categories.…”

“…Furthermore, our cohort consists of only children less than 16 years old. Ferritin levels in adults might have different connotations as they are less likely to have SPL but rather present with a higher frequency of organ impairment and severe bleeding, perhaps reflecting the underlying comorbid conditions (7). We could not perform a meaningful comparison of outcomes among those who recovered with supportive therapy alone versus those who also received immunomodulation as the latter group was too small.…”

Lebensrettende Maßnahmen bei Kindern (Paediatric Life Support, PLS)

“…Spezifische Krankheiten (z. B. Dengue-Fieber, zerebrale Malaria) können von einer früheren Verwendung von Albumin 4,5 % zur Volumentherapie profitieren [ 29 , 270 ].…”

Dengue, Zika Fever e Chikungunya: Aspectos Biológicos e Situação na América do Sul entre 2015 e 2020

“…Thus, the course of the infection does not correlate with the high viral load. In contrast, primary infections in infants born to dengue immune mothers develop severe symptoms such as hemorrhage (Ranjit, et al, 2018).…”