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Aggressive management of dengue shock syndrome may decrease mortality rate: a suggested protocol.

Suchitra Ranjit1, Niranjan Kissoon, Indira Jayakumar

  • 1Pediatric Intensive Care Unit, Apollo Hospitals, Chennai, India.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|June 29, 2005
PubMed
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Implementing an aggressive management protocol significantly reduced mortality in children with dengue shock syndrome. This approach improved outcomes by optimizing fluid management and interventions, leading to better survival rates.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Dengue shock syndrome (DSS) is a major cause of mortality in children in India.
  • Aggressive management protocols are crucial for improving outcomes in severe DSS cases.

Purpose of the Study:

  • To compare the effectiveness of a new aggressive management protocol versus standard World Health Organization (WHO) guidelines for pediatric dengue shock syndrome.
  • To evaluate key outcomes including ventilation duration, pediatric intensive care unit (PICU) stay, acute respiratory distress syndrome (ARDS) incidence, and mortality rates.

Main Methods:

  • A retrospective chart review was conducted comparing two groups of pediatric patients with DSS.
  • The standard therapy group (W) received WHO-recommended treatment (n=114), while the protocol group (P) received aggressive management (n=96).

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  • Outcomes were compared between the groups, focusing on ventilation, PICU stay, ARDS, and mortality.

    • Main Results:

    • The protocol group (P) received more fluids in the first hour and had fluid actively removed more often compared to the WHO guidelines group (W).
    • While ventilation and ARDS incidence were similar overall, severe DSS cases (dengue hemorrhagic fever grade IV) showed higher ventilation and ARDS rates in the W group.
    • The protocol group (P) experienced significantly shorter ventilation duration and PICU stay, and lower PICU mortality (6.3% vs. 16.6%).

    Conclusions:

    • Aggressive management of dengue shock syndrome, including judicious fluid removal, significantly improves survival rates in critically ill children.
    • The implemented protocol led to better outcomes compared to standard WHO guidelines, highlighting the importance of tailored critical care strategies.