The Use of Colloids and Crystalloids in Pediatric Dengue Shock Syndrome: a Systematic Review and Meta-analysis* Sharon Lyn R. Jalac,1 M.D., Michelle de Vera,1 M.D., and Marissa M. Alejandria,2 M.D. ABSTRACT Background: The cornerstone of therapy for dengue shock syndrome (DSS) remains to be the prompt and aggressive restoration of circulating plasma volume. Two common types of intravenous uids currently used in DSS are crystalloids and colloids. The debate is ongoing on whether one is superior to the other in critically ill patients. Objective: This systematic review aims to compare the therapeutic effects of colloids versus crystalloids in reducing the recurrence of shock, the requirement for rescue uids, the need for diuretics, the total volume of intravenous uids given, the hematocrit level and pulse rates, and mortality rates of children with DSS. Search strategy: We searched Medline 1966 to August 2008, the Cochrane Controlled Trials Register (The Cochrane Library Issue 1, 2008), and the Philippines Herdin database 1964 to 2008. Local journals were handsearched and reference lists were examined. Researchers and experts in the eld were contacted for unpublished or ongoing trials. Selection criteria: The studies included were randomized controlled trials comparing colloids versus crystalloids in children less than 18 years with a diagnosis of DSS. Data collection and analysis: Two reviewers independently did trial selection and assessment of methodologic quality using the Cochrane Infectious Diseases Group criteria.Two reviewers independently extracted the data and analyzed it using Review Manager Version 5. Results: Of eight studies initially reviewed, four studies ful lled the selection criteria (N=694, colloids=410, crystalloids=284). Colloids and crystalloids did not differ signi cantly in decreasing the risk for recurrence of shock (RR 0.92, 95% CI 0.62 to 1.38), the need for rescue uids (RR 0.90, 95% CI 0.70 to 1.16), total volume of intravenous uids given (WMD 0.80, 95% CI -1.68 to 3.28) and the need for diuretics (RR=1.17, 95% CI 0.84 to 1.64). However, there were signi cant improvements from baseline in the hematocrit levels (WMD -3.37, 95% CI -5.94 to -0.80) and pulse rates (WMD -3.37, 95% CI -5.94 to -0.8) of patients who were given colloids. Tests for heterogeneity were not signi cant. Allergic type reactions were seen in patients given colloids. One child died in the colloid group. Conclusion: Colloids decreased the hematocrit and pulse rates of children with DSS after the rst two hours of uid resuscitation. However, no signi cant advantage was found over crystalloids in reducing the recurrence of shock, the need for rescue colloids, the total amount of uids, the need for diuretics, and in reducing mortality. KEYWORDS: Meta-analysis, Crystalloids, Colloids, Pediatric, Dengue shock syndrome Department of Pediatrics, The Medical City Department of Clinical Epidemiology, UP College of Medicine
*Best Paper, The Medical City Interdepartmental Research Forum, 2008
Philippine Journal of Microbiology and Infectious Diseases Vol. 39, Issue 1, January-June 2010
of lifesaving F luid resuscitation is oneshock thecritically ill cornerstones in managing in patients. Physicians have an array of intravenous uids to choose from, however, the debate continues on which type of uid would be most bene cial. One condition that would bene t most from smart uid choice is dengue shock syndrome (DSS). DSS is the most serious manifestation of dengue hemorrhagic fever (DHF). The burden of disease is greatest in Asia, where in many countries dengue is a leading cause of pediatric hospitalization. An estimated 500,000 patients with severe dengue require hospitalization each year, a large proportion of which are children. At least 2.5% of patients die, although case fatality could be twice as high.1 The major pathophysiological event seen in DSS is the acute increase in vascular...