title: State-of-the-art monitoring in treatment of dengue shock syndrome: a case series.
abstract: BACKGROUND
  Early recognition and treatment of circulatory volume loss is essential in the clinical management of dengue viral infection. We hypothesized that a novel computational algorithm, originally developed for noninvasive monitoring of blood loss in combat casualties, could: (1) indicate the central volume status of children with dengue during the early stages of "shock"; and (2) track fluid resuscitation status.
  
  
  METHODS
  Continuous noninvasive photoplethysmographic waveforms were collected over a 5-month period from three children of Thai ethnicity with clinical suspicion of dengue. Waveform data were processed by the algorithm to calculate each child's Compensatory Reserve Index, where 1 represents supine normovolemia and 0 represents the circulatory volume at which hemodynamic decompensation occurs. Values between 1 and 0 indicate the proportion of reserve remaining before hemodynamic decompensation.
  
  
  RESULTS
  This case report describes a 7-year-old Thai boy, another 7-year-old Thai boy, and a 9-year-old Thai boy who exhibited signs and symptoms of dengue shock syndrome; all the children had secondary dengue virus infections, documented by serology and reverse transcriptase polymerase chain reaction. The three boys experienced substantial plasma leakage demonstrated by pleural effusion index >25, ascites, and >20 % hemoconcentration. They received fluid administered intravenously; one received a blood transfusion. All three boys showed a significantly low initial Compensatory Reserve Index (≥0.20), indicating a clinical diagnosis of "near shock". Following 5 days with fluid resuscitation treatment, their Compensatory Reserve Index increased towards "normovolemia" (that is, Compensatory Reserve Index >0.75).
  
  
  CONCLUSIONS
  The results from these cases demonstrate a new variation in the diagnostic capability to manage patients with dengue shock syndrome. The findings shed new light on a method that can avoid possible adverse effects of shock by noninvasive measurement of a patient's compensatory reserve rather than standard vital signs or invasive diagnostic methods.
authors.affiliation: Department of Surgery, University of Colorado, School of Medicine, 12631 E. 17th Avenue, C-305, Aurora, CO, 80045, USA.|Flashback Technologies, Inc., 7490 Clubhouse Rd, Boulder, CO, 80301, USA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Moulton
authors.affiliation: Flashback Technologies, Inc., 7490 Clubhouse Rd, Boulder, CO, 80301, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Mulligan
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA, 01655, USA.
authors.forename: Anon
authors.initials: A
authors.lastname: Srikiatkhachorn
authors.affiliation: Queen Sirikit National Institute for Child Health Hospital, 420/8 Ratchawithi Road, Thung Phaya Thai, Khet Ratchathewi, Bangkok, 10400, Thailand.
authors.forename: Siripen
authors.initials: S
authors.lastname: Kalayanarooj
authors.affiliation: Flashback Technologies, Inc., 7490 Clubhouse Rd, Boulder, CO, 80301, USA.
authors.forename: Greg Z
authors.initials: GZ
authors.lastname: Grudic
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA, 01655, USA.
authors.forename: Sharone
authors.initials: S
authors.lastname: Green
authors.affiliation: Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok, 10400, Thailand.|US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX, 78234-7549, USA.
authors.forename: Robert V
authors.initials: RV
authors.lastname: Gibbons
authors.affiliation: US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX, 78234-7549, USA.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Muniz
authors.affiliation: US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX, 78234-7549, USA.
authors.forename: Carmen
authors.initials: C
authors.lastname: Hinojosa-Laborde
authors.affiliation: Department of Cell and Molecular Biology, University of Rhode Island, 393 CBLS, 120 Flagg Road, Kingston, Rhode Island, 02881, USA.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Rothman
authors.affiliation: Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok, 10400, Thailand.|Viral Diseases, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Thomas
authors.affiliation: US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX, 78234-7549, USA. victor.a.convertino.civ@mail.mil.
authors.forename: Victor A
authors.initials: VA
authors.lastname: Convertino
mesh_terms: D000465:Algorithms; D001794:Blood Pressure; D001803:Blood Transfusion; D002648:Child; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D008297:Male; D017156:Photoplethysmography; D019595:Severe Dengue / Q000503:physiopathology* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Decision support; Dengue shock syndrome; Machine learning; Pulse oximetry