Authors: Ira Dharmawati, Andri Kurnia Wahyudhi, Intani Dewi Syahti Fauzi, Arina Setyaningtyas, Dwi Putri Lestari, Neurinda Permata Kusumastuti, Abdul Latief Azis
Objective: Shock in dengue hemorrhagic fever (DHF) is mostly caused by plasma leakage. Hemodynamic monitoring is essential for improving the quality of management and the outcome. We sought to find the hemodynamic profile of dengue hemorrhagic fever children with shock.
Design: a cohort prospective study.
Setting: Pediatric Intensive Care Unit (PICU) at tertiary general hospital in Surabaya, Indonesia.
Patients and participants: Children <18-year-old admitted to the PICU with diagnosis DHF with shock.
Intervention: All patients underwent measurement of hemodynamic profile with electrical cardiometry ICON OsypkaTM after the first fluid resuscitation.
Measurements and results: There were 37 patients with DHF grade 3. All patients had normal blood pressure on first examination, with the mean of systolic and diastolic blood pressure were 82.5±9.21 mmHg and 51.8±16.32 mmHg, respectively. They had low stroke volume (66.7%), high heart rate (60.6%), low cardiac output (49%), and high systemic vascular resistance (55%). Mean resuscitation fluid volume was 35.30±31.99 ml/kg, where referral patient had significantly higher resuscitation fluid volume (49.45±39.46 ml/kg) than non-referral (19.75±0.60 ml/kg), p=0.002. Thoracic fluid content were significantly higher in referral (75%) than those in non-referral patients (16.7%), p=0.001.
Conclusion: After first fluid resuscitation, children with DHF grade 3 obtained normal blood pressure but still in hypovolemic state. Referral patients had higher fluid volume resuscitation and thoracic fluid content than those in non-referral.