Intensive Care Unit Fluid Therapy in Severe Dengue Infection: Liberal versus Restrictive
Objective: Effective fluid management is important to achieve adequate perfusion during critical and recovery phases of severe dengue infection (SDI).
Methods: This study involved 113 patients with SDI during critical phase in the intensive care unit (ICU) and was divided into Group Liberal (GL) and Group Restrictive (GR) based on the fluid management received. Both groups were compared in terms of demographic data, organ dysfunctions, duration of ICU stay, ventilation support and mortality. Risk factors for each significant outcome within group were evaluated.
Results: Patients in GL had significantly increased incidence of cardiovascular (CVS) dysfunction (67.2 vs 46.0%), duration of ICU stay (3.8 vs 2.8 days) and mortality (12.1 vs 0.0%) when compared to GR. The risk of CVS dysfunction is increased in patients from cluster dengue area receiving liberal fluid (OR 3.56, 95% CI 1.00-12.68, p=0.043). Those in GL with blood transfusion (OR 37.50, 95% CI 3.14-448.59, p=0.001) and Acute Physiology and Chronic Health Evaluation (APACHE) II score ≥25 (OR 66.67, 95% CI 5.57-797.49, p<0.001) was predisposed to higher mortality. The APACHE II score ≥ 25 was also a significant independent predictor of mortality (OR 53.63, 95% CI 3.31-869.68, p=0.005).
Conclusion: Liberal fluid management particularly blood transfusion and APACHE II score ≥ 25 in patients with SDI residing in cluster dengue area increases the risk of cardiovascular dysfunction, mortality and prolonged the duration of ICU stay.
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