ĐẶC ĐIỂM TÁI SỐC VÀ SUY HÔ HẤP CỦA BỆNH NHÂN ĐƯỢC ĐIỀU TRỊ THEO PHÁC ĐỒ SỐC SỐT XUẤT HUYẾT DENGUE TUỔI THIẾU NIÊN TẠI BỆNH VIỆN NHI ĐỒNG 1

Abstract

Introduction: The volume of fluid administered based on body weight for pediatric patients in the treatment of Dengue shock syndrome (DSS) is consistently higher than that for adults. Given the current nutritional status of Vietnamese children, the physical development of adolescents aged 13–16 is approaching that of adults. Applying pediatric treatment protocols to this age group results in an increased total volume of fluid infusion and associated complications. The adolescent Dengue shock syndrome management protocol, with a tendency toward reduced fluid administration, may be associated with an increased risk of recurrent shock and a decreased incidence of respiratory failure. This study describes these two clinical features during the initial implementation of the adolescent Dengue shock syndrome management protocol at Children’s Hospital 1. Objectives: Describe characteristics of recurrent shock and respiratory failure in Dengue shock syndrome adolescents.  Method: A cross-sectional study was conducted on all 248 pediatric patients aged 13 to under 16 years who were hospitalized with Dengue shock syndrome and treated according to two Dengue shock syndrome treatment protocols for adolescents and children at Children's Hospital 1 from January 1, 2018, to July 31, 2022. Results: 248 pediatric patients met the inclusion criteria, with 140 treated according to the adolescent Dengue shock syndrome protocol and 108 treated according to the pediatric protocol. The mean age was 13.2 ± 0.7 years, with a male-to-female ratio of 1:0.92. Total fluid volume and duration of fluid administration in the pediatric protocol group were 153.7 ± 48.0 ml/kg over 28.6 ± 9.5 hours, while in the adolescent protocol group they were 135.2 ± 48.5 ml/kg over 25.7 ± 7.5 hours. The colloid volumes were 89.6 ± 46.3 ml/kg and 76.8 ± 38.7 ml/kg, respectively. The rates of respiratory failure and recurrent shock were 32.7% and 11.7%, respectively, with no statistically significant differences between the two groups (p > 0.05). Patients who experienced recurrent shock had earlier onset of shock, elevated blood lactate levels, hypoalbuminemia, coagulopathy, received greater fluid volumes including more colloids, had longer fluid administration duration, and a higher rate of respiratory support requirement. Conclusion: Adolescent DSS shares similar clinical characteristics with younger pediatric patients; however, the volume of resuscitation fluids used is lower. The application of the adolescent DSS treatment protocol reduces the total volume of therapeutic fluid administered without increasing the rates of recurrent shock or respiratory failure.