Evaluation of sublingual microcirculation in children with dengue shock

OBJECTIVE: To report the sublingual microcirculation observed using Sidestream Dark Field imaging in two children with dengue shock. METHOD: Two children, aged 9 and 10 years, were admitted to the pediatric intensive care unit with dengue shock and multiple organ dysfunction. Sublingual microcircula...

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Main Authors: Daniella Mancino da Luz Caixeta, Fernanda Moraes Daniel Fialho, Zina Maria Almeida Azevedo, Paulo Ferrez Collett-Solberg, Nivaldo Ribeiro Villela, Eliete Bouskela
Format: Article
Language:English
Published: Elsevier España 2013-07-01
Series:Clinics
Subjects:
Online Access:http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322013000701061&lng=en&tlng=en
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author Daniella Mancino da Luz Caixeta
Fernanda Moraes Daniel Fialho
Zina Maria Almeida Azevedo
Paulo Ferrez Collett-Solberg
Nivaldo Ribeiro Villela
Eliete Bouskela
author_facet Daniella Mancino da Luz Caixeta
Fernanda Moraes Daniel Fialho
Zina Maria Almeida Azevedo
Paulo Ferrez Collett-Solberg
Nivaldo Ribeiro Villela
Eliete Bouskela
author_sort Daniella Mancino da Luz Caixeta
collection DOAJ
description OBJECTIVE: To report the sublingual microcirculation observed using Sidestream Dark Field imaging in two children with dengue shock. METHOD: Two children, aged 9 and 10 years, were admitted to the pediatric intensive care unit with dengue shock and multiple organ dysfunction. Sublingual microcirculation was assessed in each patient on the first and second days of shock and was assessed a final time when the patients were no longer in shock (on the day prior to extubation) using Sidestream Dark Field technology. The De Backer score and microvascular flow index were used for the analyses. RESULTS: Both patients had reduced perfused small vessel density in the first two days and showed predominantly intermittent or no microcirculation flow, as demonstrated by a low microvascular flow index. The blood flow in the large vessels was not affected. Prior to the extubation, the microvascular flow index had increased, although the perfused small vessel density remained diminished, suggesting persistent endothelial dysfunction. CONCLUSIONS: Severe microcirculation changes may be involved in the pathophysiological mechanisms that lead to the final stages of dengue shock, which is frequently irreversible and associated with high mortality rates. Microcirculatory monitoring may help elucidate the physiopathology of dengue shock and prove useful as a prognostic tool or therapeutic target.
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spelling doaj.art-b90f628a12e34eabbf4ae8afa9ef99352022-12-22T00:56:50ZengElsevier EspañaClinics1980-53222013-07-016871061106410.6061/clinics/2013(07)26S1807-59322013000701061Evaluation of sublingual microcirculation in children with dengue shockDaniella Mancino da Luz CaixetaFernanda Moraes Daniel FialhoZina Maria Almeida AzevedoPaulo Ferrez Collett-SolbergNivaldo Ribeiro VillelaEliete BouskelaOBJECTIVE: To report the sublingual microcirculation observed using Sidestream Dark Field imaging in two children with dengue shock. METHOD: Two children, aged 9 and 10 years, were admitted to the pediatric intensive care unit with dengue shock and multiple organ dysfunction. Sublingual microcirculation was assessed in each patient on the first and second days of shock and was assessed a final time when the patients were no longer in shock (on the day prior to extubation) using Sidestream Dark Field technology. The De Backer score and microvascular flow index were used for the analyses. RESULTS: Both patients had reduced perfused small vessel density in the first two days and showed predominantly intermittent or no microcirculation flow, as demonstrated by a low microvascular flow index. The blood flow in the large vessels was not affected. Prior to the extubation, the microvascular flow index had increased, although the perfused small vessel density remained diminished, suggesting persistent endothelial dysfunction. CONCLUSIONS: Severe microcirculation changes may be involved in the pathophysiological mechanisms that lead to the final stages of dengue shock, which is frequently irreversible and associated with high mortality rates. Microcirculatory monitoring may help elucidate the physiopathology of dengue shock and prove useful as a prognostic tool or therapeutic target.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322013000701061&lng=en&tlng=enDengue ShockMicrocirculationChildrenSidestream Dark Field Imaging
spellingShingle Daniella Mancino da Luz Caixeta
Fernanda Moraes Daniel Fialho
Zina Maria Almeida Azevedo
Paulo Ferrez Collett-Solberg
Nivaldo Ribeiro Villela
Eliete Bouskela
Evaluation of sublingual microcirculation in children with dengue shock
Clinics
Dengue Shock
Microcirculation
Children
Sidestream Dark Field Imaging
title Evaluation of sublingual microcirculation in children with dengue shock
title_full Evaluation of sublingual microcirculation in children with dengue shock
title_fullStr Evaluation of sublingual microcirculation in children with dengue shock
title_full_unstemmed Evaluation of sublingual microcirculation in children with dengue shock
title_short Evaluation of sublingual microcirculation in children with dengue shock
title_sort evaluation of sublingual microcirculation in children with dengue shock
topic Dengue Shock
Microcirculation
Children
Sidestream Dark Field Imaging
url http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322013000701061&lng=en&tlng=en
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