Comparison of gelatin and HES 130/0.4 solution for fluid resuscitation in children with dengue shock syndrome
Abstract
Background Dengue shock syndrome (DSS) is characterized
by severe vascular leakage and hemostasis disorder, which causes
death in 1-5% of cases. World Health Organization management
guidelines for fluid resuscitation in DSS remain empirical, rather
than evidence-based.
Objective To as sess the efficacy of ge latin compared to
hydroxyethyl starch (HES) 130/0.4 solution for fluid resuscitation
in children with DSS.
Methods We performed a multi-centered, randomized study to
compare gelatin and HES 130/0.4 solution for resuscitation of
children with DSS. We randomly assigned 25 children with DSS
to receive gelatin fluid and 25 children to receive HES 130/0.4.
Statistical analyses were performed using Chi-square and MannWhitney
tests.
Results More rapid increase in pulse pressure was noted in
subjects treated with HES 130/0.4 compared to those treated
with gelatin at 8 hours and 28 hours of therapy (P=0.037 and
P=0.048). The decrease in hematocrit in subjects treated with
HES 130/0.4 was faster than that of gelatin at 4 hours of therapy
(P=0.001). One patient died due to an unusual manifestation of
DSS. Respiratory rate decreased faster in subjects treated with
HES 130/0.4 than those treated with gelatin at 4 hours and 8
hours of therapy (P< 0.05). Body temperature remained higher
in subjects treated with gelatin than HES 130/0.4 at 36 hours and
48 hours of therapy (P< 0.05). However, the decrease in platelet
counts in subjects treated with HES 130/0.4 was more than that
of gelatin (P=0.018).
Conclusion HES 130/0.4 solution may be better for volume replacement
compared to gelatin and is safe for fluid resuscitation
in children with DSS.
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Accepted 2016-08-29
Published 2013-12-30
