A Randomized Controlled Trial Comparing Outcome of Dengue Shock Syndrome Patients Managed with Pediatric Septic Shock Protocol in the PCMC Pediatric Intensive Care Unit

Meadina  G. Cruz,; Darla Kay  A. De Guzman,; Cherryl  S. Billena,; John  Fernandez,; Benjamin  T. Lim,

A Randomized Controlled Trial Comparing Outcome of Dengue Shock Syndrome Patients Managed with Pediatric Septic Shock Protocol in the PCMC Pediatric Intensive Care Unit

Darla Kay A. De Guzman | Cherryl S. Billena | John Fernandez | Benjamin T. Lim | Meadina G Cruz

Abstract:

BACKGROUND: Dengue shock syndrome (DSS) is the most dreaded complication of Dengue fever. Debates are still ongoing regarding optimal fluid management and no randomized trials yet have been published to compare these treatment regimens. In our own PICU, DSS has been treated with the conventional way of treating septic shock. A newer protocol was introduced which may result in improved outcome of DSS patients. OBJECTIVES: To compare the outcome among DSS patients managed with two treatment protocols: Pediatric Septic Shock Protocol versus the Revised Protocol in terms of survival rate, number of complications length of PICU stay, need for diuresis or fluid removal and need for intubation and mechanical ventilator support. METHODOLOGY: This is a single-center, randomized controlled trial, with patients aged 2-19 y/o admitted at the PCMC PICU who fulfilled the WHO criteria of DSS. Patients were randomized to either of two groups: Group A received the conventional therapy or Pediatric Septic Shock Protocol and Group B received the revised protocol. Hemodynamic variables were closely monitored and pertinent laboratory parameters were noted as well. Comparison of the groups was carried out using t-test and/or its non-parametric counterpart applied both for continuous variables and frequencies. RESULTS: A total of seventy-eight (78) patients were included in the study. Baseline characteristics were similar among both treatment groups. There were three (3) mortalities under group A and one (1) mortality under Group B, secondary to refractory shock and multiple organ dysfunction syndromes. For mortality, the significant independent factor was diagnosis (whether DSSIII or DSS IV). Subjects with DSS IV were on average 55x more likely to die than those with DSSIII. For ICU stay, the significant independent factor was the treatment plan; with subjects given treatment plan B (Group B) 30% less likely to stay in the ICU for > 3 days. CONCLUSION: Patients under the revised protocol group had shorter PICU stay, and lesser trend towards occurrence of complications, need for diuresis and mechanical ventilator support. The study revealed a significant and positive outcome with the use of the revised protocol.

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