Dadang Hudaya Somasetia

Early resuscitation of dengue shock syndrome in children with hyperosmolar sodium-lactate: a randomized single-blind clinical trial of efficacy and safety

IntroductionDengue shock syndrome (DSS) fluid resuscitation by following the World Health Organization (WHO) guideline usually required large volumes of Ringer lactate (RL) that might induce secondary fluid overload. Our objective was to compare the effectiveness of the recommended volume of RL versus a smaller volume of a hypertonic sodium lactate solution (HSL) in children with DSS. The primary end point was to evaluate the effect of HSL on endothelial cell inflammation, assessed by soluble vascular cell adhesion molecule-1 (sVCAM-1) measurements. Secondarily, we considered the effectiveness of HSL in restoring hemodynamic fluid balance, acid-base status, and sodium and chloride balances, as well as in-hospital survival.MethodsA prospective randomized single-blind clinical trial including 50 DSS children was conducted in the Pediatrics Department of Hasan Sadikin Hospital, Bandung, Indonesia. Only pediatric patients (2 to 14 years old) fulfilling the WHO criteria for DSS and new to resuscitation treatments were eligible. Patients were resuscitated with either HSL (5 ml/kg/BW in 15 minutes followed by 1 ml/kg/BW/h for 12 hours), or RL (20 ml/kg/BW in 15 minutes followed by decreasing doses of 10, 7, 5, and 3 ml/kg BW/h for 12 hours).ResultsIn total, 50 patients were randomized and included in outcome and adverse-event analysis; 46 patients (8.2 ± 0.5 years; 24.9 ± 1.9 kg; mean ± SEM) completed the protocol and were fully analyzed (24 and 22 subjects in the HSL and RL groups, respectively). Baseline (prebolus) data were similar in both groups. Hemodynamic recovery, plasma expansion, clinical outcome, and survival rate were not significantly different in the two groups, whereas fluid accumulation was one third lower in the HSL than in the RL group. Moreover, HSL was responsible for a partial recovery from endothelial dysfunction, as indicated by the significant decrease in sVCAM-1.ConclusionSimilar hemodynamic shock recovery and plasma expansion were achieved in both groups despite much lower fluid intake and fluid accumulation in the HSL group.Trial RegistrationClinicalTrials.gov NCT00966628. Registered 26 August 2009.

Critical Pertussis in a Young Infant Requiring Mechanical Ventilation

Pertussis may likely be misdiagnosed in its initial or catarrhal phase as a common respiratory infection. The earlier diagnosis of pertussis really depends on the capability of the medical professional especially in the first line public health services. The lack of awareness in diagnosis of severe pertussis as one of the causes of severe respiratory problems may likely misdiagnose pertussis as respiratory failure or even septic shock. In fact, pertussis may manifest as a critical pertussis which can be fatal due to the respiratory failure that require pediatric intensive care unit using mechanical ventilation. We reported a confirmed pertussis case of a 7-weeks-old female infant referred to our tertiary hospital with gasping leading to respiratory failure and septic shock requiring mechanical ventilation, aggressive fluid therapy, and antibiotics. Pertussis was diagnosed late during the course of illness when the patient was hospitalized. Improvement was noted after administering macrolide which gave a good response. Bordetella pertussis isolation from Bordet-Gengou media culture yielded positive result.

BNP as Predictor of Pediatric Severe Sepsis Fluid Responsiveness in Limited Resource Setting Country

Fluid responsiveness is an important aspect in severe sepsis management, assessed by static and dynamic parameter tools. Unfortunately, they are not widely used in limited resource setting. Brain natriuretic peptide is cardiac hormone correlated with CVP measurement as one of the static parameter, but its associations with dynamic parameter has not studied yet. Objective: To investigate whether BNP might predict fluid responsiveness based on clinical and inferior vena cava index criteria. Study Design: A cross sectional study was conducted on 59 severe sepsis subjects aged 1–14 years who met the inclusion criteria enrolled through consecutive sampling during October 2013 to March 2014. Patients were given fluid resuscitation based on 2012 Surviving Sepsis Campaign. BNP measurements were performed at 0 and 1 hour after fluid resuscitation. Responder and non-responder groups were classified based on clinical and IVC index criteria. Ultrasound using M Mode was performed to calculate IVC index. Unpaired t test and receiver operating characteristic curves were generated for BNP to predict fluid responsiveness. Results: Baseline characteristics between responder and non-responder groups were almost similar. Initial BNP between groups using both criteria were not significantly different (p>0.05). The area under curve of BNP0 was 0.04. The best cut off values of log BNP to predict fluid responsiveness was 1.9pg/mL. BNP ≤1.9 pg/mL has a sensitivity, specificity, negative predictive value and positive predictive value of each were 50%, 50%, 50%, 50%, respectively. Conclusion: BNP cannot reflect and accurately predict fluid responsiveness due to multifactorial factors of raising BNP and mostly subject were spontaneous breathing which more difficult to predict.

Discharge against Medical Advice in Pediatric Intensive Care Unit and Subsequent Events

Objective: The occurence of discharge against medical advice (DAMA) has impacted globally. Decisions of DAMA in pediatric patients are not made by the patients, but pose life-threatening consequences, especially for children treated in Pediatrics Intensive Care Unit (PICU). The present study aimed to identify the occurence of DAMA and subsequent events to the DAMA patients after treated in PICU of Dr. Hasan Sadikin General Hospital Bandung, Indonesia. Methods: A retrospective study from medical records of DAMA patients from PICU of Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, between April 2011 and April 2012. Results: A total of 195 children aged 1–5 years were admitted. Of this number, 12 (6.2%) were DAMA. Financial problems were the most common reason for DAMA, followed by parents’ perception about their child’s terminal condition. The majority of parents were laborer. Last parents’ education level was mostly elementary school. Most patients who DAMA from PICU died in less than 24 hours. Conclusions: A considerable number of DAMA was found in our PICU. High mortality occured after patients asked for DAMA from PICU. Keywords: Discharge against medical advice (DAMA), pediatric, pediatrics intensive care unit (PICU) DOI: 10.15850/ijihs.v3n1.400