Retrospective chart review of patients admitted to the Pediatric Intensive Care Unit (PICU) of a referral children's hospital in South India with DHF over 1.5 years (2001-January 2003).
RESULTS: Of 858 patients with
dengue fever/DHF admitted to the hospital during the study period, 109 cases with severe forms of disease required PICU admission, of which 9 patients died. 77 were under 5 years of age. The commonest indication for PICU admission was persistent
shock (39 patients) followed by requirement for
positive pressure ventilation in 29 patients (10 of whom had
Acute Respiratory Distress Syndrome [ARDS]) and neurological symptoms in 24 patients. An important finding was the presence of diastolic dysfunction in 3 children. Six deaths of refractory
shock included 4 who had ARDS and
DIC and 2 who had
shock with
DIC 3 patients had
abdominal compartment syndrome (ACS) has not been previously described in children with DSS and may lead to fluid refractory
shock if not corrected. All patients had
thrombocytopenia which was a defining feature of the syndrome, while 74 were also coagulopathic and 6 had severe fatal
DIC. Hepatic dysfunction was more severe in children with prolonged
shock, however, only a fifth of cases (5/24) with
neurological manifestations were in
shock. Other significant reasons for neurological presentation included
cerebral edema and
encephalopathy secondary to hepatic dysfunction. 2 children had features of
Acute Disseminated Encephalomyelitis (ADEM), previously only described in adults with
dengue.
CONCLUSION: It was found that complications such as
DIC, diastolic dysfunction,
abdominal compartment syndrome, ARDS and hepatic dysfunction were more frequent in severe established
shock. However, most neurological events were unrelated to the perfusion status. Children referred late were harder to resuscitate. There were 9 PICU deaths (case fatality rate of 8.35%). Severe refractory
shock,
DIC, ARDS,
hepatic failure and
neurological manifestations singly or in combination were the commonest causes of death in the present study.