title: Dynamic Measurement of Hemodynamic Parameters and Cardiac Preload in Adults with Dengue: A Prospective Observational Study.
abstract: Few previous studies have monitored hemodynamic parameters to determine the physiological process of dengue or examined inferior vena cava (IVC) parameters to assess cardiac preload during the clinical phase of dengue. From January 2013 to July 2015, we prospectively studied 162 hospitalized adults with confirmed dengue viral infection using non-invasive cardiac output monitoring and bedside ultrasonography to determine changes in hemodynamic and IVC parameters and identify the types of circulatory shock that occur in patients with dengue. Of 162 patients with dengue, 17 (10.5%) experienced dengue shock and 145 (89.5%) did not. In patients with shock, the mean arterial pressure was significantly lower on day 6 after fever onset (P = 0.045) and the pulse pressure was significantly lower between days 4 and 7 (P<0.05). The stroke volume index and cardiac index were significantly decreased between days 4 and 15 and between days 5 and 8 after fever onset (P<0.05), respectively. A significant proportion of patients with dengue shock had an IVC diameter <1.5 cm and IVC collapsibility index >50% between days 4 and 5 (P<0.05). Hypovolemic shock was observed in 9 (52.9%) patients and cardiogenic shock in 8 (47.1%), with a median (interquartile range) time to shock onset of 6.0 (5.0-6.5) days after fever onset, which was the median day of defervescence. Intravascular hypovolemia occurred before defervescence, whereas myocardial dysfunction occurred on the day of defervescence until 2 weeks after fever onset. Hypovolemic shock and cardiogenic shock each occurred in approximately half of the patients with dengue shock. Therefore, dynamic measures to estimate changes in hemodynamic parameters and preload should be monitored to ensure adequate fluid therapy among patients with dengue, particularly patients with dengue shock.
authors.affiliation: Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Vipa
authors.initials: V
authors.lastname: Thanachartwet
authors.affiliation: Pulmonary and Critical Care Division, Department of Medicine, Phramongkutklao Hospital, Bangkok 10400, Thailand.
authors.forename: Anan
authors.initials: A
authors.lastname: Wattanathum
authors.affiliation: Information Technology Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Duangjai
authors.initials: D
authors.lastname: Sahassananda
authors.affiliation: Critical Care Division, Department of Anesthesiology, Phramongkutklao Hospital, Bangkok 10400, Thailand.
authors.forename: Petch
authors.initials: P
authors.lastname: Wacharasint
authors.affiliation: Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Supat
authors.initials: S
authors.lastname: Chamnanchanunt
authors.affiliation: Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Ei
authors.initials: E
authors.lastname: Khine Kyaw
authors.affiliation: Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Akanitt
authors.initials: A
authors.lastname: Jittmittraphap
authors.affiliation: Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Mali
authors.initials: M
authors.lastname: Naksomphun
authors.affiliation: Pulmonary and Critical Care Division, Department of Medicine, Ramkhamhaeng Hospital, Bangkok 10240, Thailand.
authors.forename: Manoon
authors.initials: M
authors.lastname: Surabotsophon
authors.affiliation: Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Varunee
authors.initials: V
authors.lastname: Desakorn
mesh_terms: D000328:Adult; D003715:Dengue / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006334:Heart Function Tests; D006439:Hemodynamics; D006801:Humans; D008297:Male; D012769:Shock / Q000175:diagnosis* / Q000209:etiology; D014463:Ultrasonography