Initial fluid resuscitation for children with dengue shock syndrome: a systematic review

ABSTRACT

Background: Currently, there is no standard recommendation of fluid resuscitation in dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS). The types of fluid as initial choice for resuscitation are still questionable. It is important to review what type of fluid is used for clinical outcome improvement. Objective: To assess the effectiveness and safety of fluid for initial resuscitation of DSS in children. Methods: Randomized control trials (RCTs) of initial fluid resuscitation in 1-15 years-old DSS children were researched. Characteristics of the study (design, methods of randomization, and withdraws/dropouts), participants (age), intervention (type, dose and duration, and fluid after the ending of intervention), outcomes (types of outcome measures, timing, and adverse events), and results were extracted from three selected RCTs. Results: Moderate DSS had no significant difference between each type of crystalloids and colloids in volume of rescue colloid and pulse pressure recovery time (PPRT). In severe DSS, colloids had significantly less median PPRT than crystalloids. Additionally, no difference was found in the incidence of allergic reaction from all the RCTs in both moderate and severe DSS. Conclusion: In moderate DSS, there is no significant difference between crystalloids (Ringer’s lactate solution/normal saline solution) and colloids (dextran/hydroxyethyl starch/gelatin) in the initial fluid resuscitation. The decision in choosing the appropriate type of fluid depends on the physician’s judgment. Some data suggest colloids as the fluid of choice for the initial resuscitation in severe DSS, but there is no significant evidence to support this data. Moreover, any type of colloid is not significantly different from one another. The decision in choosing fluid also depends on the physician’s judgment.