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Hemodynamic response to high-dose methyl prednisolone and mannitol in severe dengue-shock patients unresponsive to
P Futrakul1, M Poshyachinda, C Mitrakul
1Department of Pediatrics, Faculty of Medicine, Chulalongkorn Medical School Hospital, Bangkok, Thailand.
Insights
High-dose methylprednisolone and mannitol improved circulation in children with dengue shock syndrome unresponsive to standard treatments. Seven of nine patients showed better tissue perfusion and circulatory blood volume.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Dengue shock syndrome (DSS) is a severe manifestation of dengue infection, characterized by poor tissue perfusion.
- Standard fluid resuscitation (saline and plasma) can be insufficient for some DSS patients.
Purpose of the Study:
- To evaluate the efficacy of high-dose methylprednisolone (MP) and mannitol (M) in pediatric patients with DSS refractory to conventional therapy.
Main Methods:
- Nine pediatric patients (4 male, 5 female; age 2.5-13 years) with DSS and poor tissue perfusion were treated with high-dose MP (all 9) and M (6/9).
- Treatment efficacy was assessed by changes in central venous pressure (CVP), pulse pressure (PP), pulse rate (PR), and clinical signs of tissue perfusion.
Main Results:
- Seven out of nine patients demonstrated significant improvement in circulatory blood volume, indicated by sustained CVP increase, widened PP, and decreased PR.
- Clinical signs of tissue perfusion improved in these seven patients following high-dose MP and M administration.
Conclusions:
- High-dose methylprednisolone combined with mannitol shows promise as an adjunctive therapy for pediatric dengue shock syndrome unresponsive to initial fluid resuscitation.
- This therapeutic approach may help restore effective circulatory blood volume and improve tissue perfusion in severe DSS cases.
Abstract:
Nine children; 4 males and 5 females, aged ranging from 2 1/2 to 13 years presented with signs and symptoms of poor tissue perfusion associated with dengue shock syndrome. All these 9 patients were subjected to the therapeutic trial of high dose methyl prednisolone (MP; 9/9) and mannitol (M; 6/9) after their failure to the saline and plasma replacement. Following the high dose MP and M, a significant increment in the effective circulatory blood volume as reflected by the sustained increment in CVP, widening of PP and declining in PR as well as improvement in clinical tissue perfusion were established in 7 of these nine patients so treated.