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Pediatric Profound Dengue Shock Syndrome and Use of Point-of-Care Ultrasound During Mechanical Ventilation to Guide Treatment: Single-Center Retrospective Study, 2013-2021.


ABSTRACT:

Objectives

Profound dengue shock syndrome (DSS) complicated by severe respiratory failure necessitating mechanical ventilation (MV) accounts for high case fatality rates among PICU-admitted patients. A major challenge to management is the assessment of intravascular volume, which can be hampered by severe plasma leakage and the use of MV.

Design

Retrospective cohort, from 2013 to 2021.

Patients

Sixty-seven children with profound DSS supported by MV, some of whom underwent bedside point-of-care ultrasound (POCUS) for assessment and monitoring of hemodynamics and fluid administration.

Setting

PICU of the tertiary Children's Hospital No. 2 in Vietnam.

Interventions

None.

Measurements and main results

We analyzed data clinical and laboratory data during PICU stay. In particular, during use of MV (i.e., at times 0-, 6-, and 24-hr after commencement) and fluid resuscitation. The primary study outcome was 28-day in-hospital mortality, and the secondary outcomes were associations with changes in hemodynamics, blood lactate, and vasoactive-inotrope score (VIS). Patients had a median age of 7 years (interquartile range, 4-9). Use of POCUS during fluid management (39/67), as opposed to not using (28/67), was associated with lower mortality (6/39 [15%] vs. 18/28 [64%]; difference 49 % [95% CI, 28-70%], p < 0.001). Use of POCUS was associated with lower odds of death (adjusted odds ratio 0.17 [95% CI, 0.04-0.76], p = 0.02). The utilization of POCUS, versus not, was associated with greater use of resuscitation fluid, and reductions in VIS and pediatric logistic organ dysfunction (PELOD-2) score at 24 hours after MV and PICU discharge.

Conclusions

In our experience of pediatric patients with profound DSS and undergoing MV (2013-2021), POCUS use was associated with lower odds of death, a higher volume of resuscitation fluid, and improvements in the blood lactate levels, VIS, and PELOD-2 score.

SUBMITTER: Vo LT 

PROVIDER: S-EPMC10986784 | biostudies-literature | 2024 Apr

REPOSITORIES: biostudies-literature

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Publications

Pediatric Profound Dengue Shock Syndrome and Use of Point-of-Care Ultrasound During Mechanical Ventilation to Guide Treatment: Single-Center Retrospective Study, 2013-2021.

Vo Luan Thanh LT   Nguyen Dat Tat DT   Tran Thinh Ngoc TN   Tran Hang Hoang-Thanh HH   Đoan Trang Thi-Hoai TT   Pham Tram Ngoc TN   Mai Thanh Thi-Hoai TT   Nguyen Quynh Xuan-Thuy QX   Nguyen Thuan Khac TK   Nguyen Thuong Thi-Kim TT   Burza Sakib S   Nguyen Thanh Tat TT  

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 20231115 4


<h4>Objectives</h4>Profound dengue shock syndrome (DSS) complicated by severe respiratory failure necessitating mechanical ventilation (MV) accounts for high case fatality rates among PICU-admitted patients. A major challenge to management is the assessment of intravascular volume, which can be hampered by severe plasma leakage and the use of MV.<h4>Design</h4>Retrospective cohort, from 2013 to 2021.<h4>Patients</h4>Sixty-seven children with profound DSS supported by MV, some of whom underwent b  ...[more]

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