Respiratory Distress Associated with Dengue Hemorrhagic Fever on Paediatric Patients: Learning from a Provincial Hospital in Southern Vietnam

Introduction: Respiratory distress is serious issue in dengue hemorrhagic fever (DHF), especially in children. Appropriate and timely intervention for treatment of respiratory distress is a prerequisite for treatment success; however, this requires appropriate preparation of personnel and equipment. Therefore, further research is needed on the rate, the associated factors, and the severity of respiratory distress. Objective: The aim of this study was to investigate DHF treatment in a provincial pediatric hospital in southern of Vietnam. Methods: This was a cross-sectional study conducted between January 2015 and June 2017 at Dongnnai Paediatric Hospital (DPH). All DSS cases treated at DPH in the study period were invited to participate in the study. The NS1 rapid test, combined with an IgM test, was used to indicate DHF.

Results: In total, 1,085 pediatric patients were admitted to DPH, and 800 of them developed dengue shock syndrome (DSS); the mortality rate was 0.3%. The average age of DSS patients was 9.3 ± 3 years. A total of 137 patients (17.1%) suffered from respiratory distress. The onset of respiratory distress was 23.6 hours after resuscitation with fluid, and 76.3% of these patients received respiratory support with nasal continuous positive airway pressure (CPAP). Mechanical ventilation was required in 5.9% of patients; the shortest time of mechanical ventilation was 1.5 days and the maximum were 13 days. The epidemiology, signs, and treatment of respiratory distress are associated with many factors, including age, mucosal hemorrhage, hematocrit (Hct), albumin, blood lactate at shock, total fluid volume, molecule fluid volume, number of hours of infusion, amount of urine during infusion, and rate of re-shock. Conclusion: The respiratory failure in children with DSS has a rate of 17.1%, is mostly at the moderate level, and requires CPAP. Young age, high plasma loss, re-shock, and the volume of parenteral administration are factors that contribute to respiratory distress in pediatric DHF cases.