Targeted Interventions in Critically Ill Children with Severe Dengue
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".