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Submitted: 08 April 2014 Modified: 04 May 2017
HERDIN Record #: NCR-TMC-14040814202825

The use of Colloids and Crystalloids in Pediatric Dengue Shock Syndrome: A meta analysis.

Marissa M. Alejandria

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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 fluids currently used in DSS are crystalloids and colloids. The debate on whether colloid or crystalloid is superior to the other in critically ill patients is ongoing. OBJECTIVE: To compare the therapeutic effects of colloids versus crystalloids in reducing the recurrence of shock, the requirement for rescue fluids, the need for diuretics, the total volume of intravenous fluids given, the hematocrit level and pulse rates, and mortality rates of children with DSS. SEARCH STRATEGY: We search Medline 1966 to August 2008, the Cochrane Controlled Trials Register (The Cochrane Library Issue 1, 2008), and the Herdin database of the Philippines 1964 to 2008. Local journals were hand searched and reference lists were examined. Researchers and experts in the field were contacted for unpublished or ongoing trials. SELECTION CRITERIA: Studied 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 did trial selection and assessment of methodologic quality independently using the Cochrane Infectious Disease Group criteria. Data were extracted independently by two reviewers and analyzed using Review Manager Version 5. RESULTS: Of eight studies initially reviewed, four studied fulfilled the selection criteria (N=694; colloids=410, crystalloids=284). Colloids and crystalloids did not differ significantly in decreasing the risk for recurrence of shock (RR 0.92, 95% CI 0.62 to 1.38), the need for rescue fluids ( RR 0.90, 95% CI 0.70 to 1.16), total volume of IV fluids 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 significant 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 -0.80) of patients given colloids. tests for heterogeneity were not significant. Allergic type reactions were seen in patients given colloids. There was only one mortality. CONCLUSION: Colloids decreased the hematocrit and pulse rates of children with DSS after the first two hours of fluid resuscitation. It has no significant advantage over crystalloids in reducing the recurrence of shock, the need for rescue colloids, the total amount of fluids, the need for diuretics and in reducing mortality.

Publication Type
Research Report
Date
April 8, 2009-April 8, 2014

Objectives

To compare the therapeutic effects of colloids versus crystalloids in reducing the recurrence of shock, the requirement for rescue fluids, the need for diuretics, the total volume of intravenous fluids given, the hematocrit level and pulse rates, and mortality rates of children with DSS.

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The Medical City - Research Office Fulltext Print Format
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