Fluid replacement in dengue shock syndrome: a randomized, double-blind comparison of four intravenous-fluid regimens

Area of Science:

• Pediatrics
• Infectious Diseases
• Critical Care Medicine

Background:

• Dengue hemorrhagic fever and Dengue Shock Syndrome (DSS) are significant causes of severe illness and death in children globally.
• The primary characteristic of DSS is shock resulting from increased intravascular permeability and plasma leakage.
• Fluid resuscitation is the critical treatment for managing plasma leakage in DSS.

Purpose of the Study:

• To compare the efficacy of four intravenous fluid regimens for acute resuscitation in children with DSS.
• To evaluate the impact of different fluid types (colloids vs. crystalloids) on hemodynamic parameters and hematocrit levels.

Main Methods:

• A double-blind, randomized trial involving 50 children diagnosed with DSS.
• Comparison of four intravenous fluid regimens: dextran 70, gelafundin 35,000 (colloids), Ringer's lactate, and 0.9% saline (crystalloids).
• Assessment of cardiac index, blood pressure, and hematocrit normalization rates.

Main Results:

• Colloid solutions (dextran 70 and gelafundin) demonstrated faster restoration of cardiac index and blood pressure compared to crystalloids.
• Dextran 70 significantly accelerated hematocrit normalization and cardiac index recovery with no observed adverse effects.
• Both colloid solutions were more effective than crystalloids in managing plasma leakage.

Conclusions:

• Dextran 70 may be the preferred fluid for acute resuscitation in Dengue Shock Syndrome due to its rapid and effective normalization of key clinical indicators.
• Further large-scale, double-blind trials are necessary to establish evidence-based guidelines for DSS fluid management.