Abstract | BACKGROUND:
Dengue shock syndrome is characterized by severe vascular leakage and disordered hemostasis and progresses to death in 1 to 5 percent of cases. Although volume replacement is recognized as the critical therapeutic intervention, World Health Organization management guidelines remain empirical rather than evidence-based. METHODS: RESULTS: Only one patient died (<0.2 percent mortality). The primary outcome measure--requirement for rescue colloid--was similar for the different fluids in the two severity groups. The relative risk of requirement for rescue colloid was 1.08 (95 percent confidence interval, 0.78 to 1.47; P=0.65) among children with moderate shock who received Ringer's lactate as compared with either of the colloid solutions, 1.13 (95 percent confidence interval, 0.74 to 1.74; P=0.59) among children who received dextran as compared with starch in the group with severe shock, and 0.88 (95 percent confidence interval, 0.66 to 1.17; P=0.38) among children who received dextran as compared with starch in the combined analysis. Although treatment with Ringer's lactate resulted in less rapid improvement in the hematocrit and a marginally longer time to initial recovery than did treatment with either of the colloid solutions, there were no differences in all other measures of treatment response. Only minor differences in efficacy were detected between the two colloids, but significantly more recipients of dextran than of starch had adverse reactions. Bleeding manifestations, coagulation derangements, and severity of fluid overload were similar for all fluid-treatment groups. CONCLUSIONS:
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Authors | Bridget A Wills, M Dung Nguyen, T Loan Ha, T H Tam Dong, T N Thuy Tran, T T Minh Le, V Diet Tran, T Hao Nguyen, V Chau Nguyen, Kasia Stepniewska, Nicholas J White, Jeremy J Farrar |
Journal | The New England journal of medicine
(N Engl J Med)
Vol. 353
Issue 9
Pg. 877-89
(Sep 01 2005)
ISSN: 1533-4406 [Electronic] United States |
PMID | 16135832
(Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | Copyright 2005 Massachusetts Medical Society. |
Chemical References |
- Dextrans
- Hydroxyethyl Starch Derivatives
- Isotonic Solutions
- Rehydration Solutions
- Ringer's Lactate
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Topics |
- Adolescent
- Blood Coagulation Tests
- Child
- Child, Preschool
- Dextrans
(adverse effects, therapeutic use)
- Double-Blind Method
- Female
- Fluid Therapy
(adverse effects)
- Humans
- Hydroxyethyl Starch Derivatives
(adverse effects, therapeutic use)
- Infusions, Intravenous
- Isotonic Solutions
(adverse effects, therapeutic use)
- Male
- Rehydration Solutions
(adverse effects, therapeutic use)
- Resuscitation
(methods)
- Ringer's Lactate
- Severe Dengue
(therapy)
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