Targeted Interventions in Critically Ill Children with Severe Dengue
Notice bibliographique
Résumé
IntRoductIonOutcomes of dengue infections are usually excellent; [1][2][3] however, mortality in severe dengue (SD) shock can be as high as 44%-72%, [4][5][6][7] with fluid overload (FO) and malignant edema due to capillary leak being major contributors.[1][2][3][4][5][6][7] While FO has been alluded to both in the World Health Organization (WHO) guideline and our dengue publications, [3,6,7] therapeutic interventions to manage malignant edema and prevent treatment morbidity have not been fully described.Cognizant of this shortcoming, we focused on several pathophysiology-based Intensive Care Unit (ICU) and emergency department (ED) interventions which may be useful in severe and refractory dengue shock.In this prospective observational study, we aimed to determine the effect of these proactively applied interventions on mortality, positive fluid balance (PFB), ventilator requirements, Pediatric ICU (PICU) days, and mortality as compared to a matched retrospective cohort with SD who received standard therapy (ST) as per the WHO guidelines. subjects and Methods Setting and patient selectionConsecutive patients aged 2 months to 16 years with SD admitted to a 10-bed PICU between September 2009 and November 2015 were included.All patients received ST as per the WHO guidelines.[1] However, patients admitted from October 2011 to November 2015 also received one or more targeted interventions in addition to standard therapy (ST+) in Background: The World Health Organization guidelines provide suggestions on early recognition and treatment of severe dengue (SD); however, mortality in this group can be high and is related both to disease severity and the treatment complications.Subjects and Methods: In this prospective observational study, we report our results where standard therapy (ST) was enhanced by Intensive Care Unit (ICU) supportive measures that have proven beneficial in other conditions that share similar pathophysiology of capillary leak and fluid overload.These include early albumin for crystalloid-refractory shock, proactive monitoring for symptomatic abdominal compartment syndrome (ACS), application of a high-risk intubation management protocol, and other therapies.We compared outcomes in a matched retrospective cohort who received ST.Results: We found improved outcomes using these interventions in patients with the most devastating forms of dengue (ST+ group).We could demonstrate decreased positive fluid balance on days 1-3 and less symptomatic ACS that necessitated invasive percutaneous drainage (7.7% in ST+ group vs. 30% in ST group, P = 0.025).Other benefits in ST+ group included lower intubation and positive pressure ventilation requirements (18.4% in ST+ vs. 53.3% in ST, P = 0.003), lower incidence of major hemorrhage and acute kidney injury, and reduced pediatric ICU stays and mortality (2.6% in ST+ group vs. 26% in ST group, P = 0.004).Conclusion: Children with SD with refractory shock are at extremely high mortality risk.We describe the proactive application of several targeted ICU supportive interventions in addition to ST and could show that these interventions resulted in decreased resuscitation morbidity and improved outcomes in SD.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».