title: Evaluation of sublingual microcirculation in children with dengue shock.
abstract: OBJECTIVE
  To report the sublingual microcirculation observed using Sidestream Dark Field imaging in two children with dengue shock.
  
  
  METHODS
  Two children, aged 9 and 10 years, were admitted to the pediatric intensive care unit with dengue shock and multiple organ dysfunction. Sublingual microcirculation was assessed in each patient on the first and second days of shock and was assessed a final time when the patients were no longer in shock (on the day prior to extubation) using Sidestream Dark Field technology. The De Backer score and microvascular flow index were used for the analyses.
  
  
  RESULTS
  Both patients had reduced perfused small vessel density in the first two days and showed predominantly intermittent or no microcirculation flow, as demonstrated by a low microvascular flow index. The blood flow in the large vessels was not affected. Prior to the extubation, the microvascular flow index had increased, although the perfused small vessel density remained diminished, suggesting persistent endothelial dysfunction.
  
  
  CONCLUSIONS
  Severe microcirculation changes may be involved in the pathophysiological mechanisms that lead to the final stages of dengue shock, which is frequently irreversible and associated with high mortality rates. Microcirculatory monitoring may help elucidate the physiopathology of dengue shock and prove useful as a prognostic tool or therapeutic target.
authors.affiliation: Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro/RJ, Brazil. daniellamancino@hotmail.com
authors.forename: Daniella Mancino da Luz
authors.initials: DM
authors.lastname: Caixeta
authors.forename: Fernanda Moraes Daniel
authors.initials: FM
authors.lastname: Fialho
authors.forename: Zina Maria Almeida
authors.initials: ZM
authors.lastname: Azevedo
authors.forename: Paulo Ferrez
authors.initials: PF
authors.lastname: Collett-Solberg
authors.forename: Nivaldo Ribeiro
authors.initials: NR
authors.lastname: Villela
authors.forename: Eliete
authors.initials: E
authors.lastname: Bouskela
mesh_terms: D002648:Child; D003952:Diagnostic Imaging; D003935:Diagnostic Techniques, Cardiovascular; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D055806:Microvessels / Q000503:physiopathology; D009060:Mouth Floor / Q000098:blood supply; D019595:Severe Dengue / Q000188:drug therapy / Q000503:physiopathology*; D013997:Time Factors; D016896:Treatment Outcome
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