versão On-line ISSN 1683-9803
DUARTE, A et al. Management of Dengue Shock Syndrome (DSS) in a Pediatric Intensive Care Unit (PICU). Pediatr. (Asunción) [online]. 2009, vol.36, n.1, pp. 11-15. ISSN 1683-9803.
Objectives: To determine the mortality and morbidity of patients admitted to the PICU. Methods: We conducted a prospective observational descriptive study at the general pediatric hospital, “Niños de Acosta Ñu”. Population: Sixteen (16) patients diagnosed with dengue from January to April 2007 who received early and rapid fluid resuscitation from shock, as per the protocol, and who required admittance to the PICU. Results: From January 1 to April 30, 2007, 113 patients were admitted to the PICU, of whom 16 (14.1%) had severe forms of dengue. The average age was 10.7 years (range: 8 months to 16 years), 7 of 16 were male and 9 of 16 female. Motive for admission was dengue shock syndrome (n: 12), septic shock (n: 1), hypovolemic shock due to metrorrhagia (n: 1), dengue fever with hemorrhagic characteristics (n: 1), hypervolemia (n: 1).The average hematocrit was 41.4% (range: 23.3 to 48). Average WBC was 3,473 mm3 (range: 1,400 to 8,300). The average platelet count was 133,750/mm3 (range: 45,000 to 317,000). Hepatic enzymes were GOT 145.6 IU/L (Range: 17 to 398) and GPT 124.1 IU/L (Range: 15 to 499). Albumin was 3.4 g/dL (Range: 2 to 4.3). Shock and bradycardia were seen in 5 patients, while 1 exhibited acute encephalopathy and 1 requires assisted ventilation for 48 hrs and 2 administrations of inotropic agents. Ultrasound showed signs of capillary leakage (ascites, perivascular edema, pleural effusion) in 12 of 16 patients. The average volume expansion administered was 32.8 ml/kg in the first hour, 25 ml/kg in hours 2-6, 60 ml/kg in hours 7-24, 36.6 ml/kg in hours 25-48, and 56 ml/kg in hours 49-72. Only 1 patient exhibited shock after 72 hours. Crystalloids were used for volume replacement in 15 of 16 patients and colloids and crytalloids in 1 of 16. One patient received a transfusion of globulin concentrate. DSS grades III and IV were found in 14 patients. The average hospital stay was 3 days (range: 1 to 7 days). Comments: Fluid management was based on rapid expansion with crystalloids, while in clinically severe cases plasma-derived products and colloids were used. Hospitalization in the PICU was brief and no deaths or multiple organ failure was reported.
Palavras-chave : Dengue; shock; management; fluid resuscitation.