Vietnam MOH guideline update on DHFtreatment

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Vietnam MOH

Guideline update on DHFtreatment
Dr Bạch Văn Cam
CH1


Contents
I. VN MOH DHF 2019 GUIDELINE
II. DIAGNOSIS AND CLASSIFICATION
III. PEDIATRIC DHF TREATMENT
IV. SEVERE DHF WITH MODS
TREATMENT
V. CONCLUSION


I. VN MOH DHF 2019 GUIDELINE


SỐT XUẤT HUYẾT DENGUE


VIETNAM
CURRENT
STATUS


DHF TREATMENT RESULTS

SURVIVAL
CMV & CRRT
implemented


FATAL CAUSES ON DHF
• PROLONGED/
SEVERE DSS
• Severe
heamorrhagic
bleeding
• ARDS/ACS with
poor lung
compliance
• MODS: ARF, ALF,
…

• Unrecognized
• Low compliance to
guideline
• Unsafe patient
transfer
• Nocosomial inf.


1. Early recognition
2. Decrease
mortality
3. Better life quality

PAHOWHO
2016

HƯỚNG DẪN
CHẨN ĐOÁN, ĐIỀU TRỊ
SỐT XUẤT HUYẾT
DENGUE

WHO 2009

HƯỚNG DẪNCHẨN
ĐOÁN, ĐIỀU TRỊ SỐT
XUẤT HUYẾT DENGUE

số 458/QĐ-BYT ngày
16 /02/2011

số 3705/QĐ-BYT ngày
22/08/2019
(2 nam soan thao
PHÁC ĐỒ SXHD)
World Health
Organization 2012


IBW for obesity children
Age (ys)
2
3

4
5
6
7
8
9
10
11
12
13
14
15

male (kg)
13
14
16
18
21
23
26
29
32
36
40
45
51
56

(CDC 2014)

Female (kg)
12
14
16
18
20
23
26
29
33
37
42
46
49
52

More affordable
than BMI
calculations
➔ Ideal for fluid resuscitation in
the first hours, but CVP is needed
for later continuing.


II. DIAGNOSIS AND
CLASSIFICATIONS


DHF

“KEY” TIMING IN DHF TREATMENT

DHF with
warnings

GOOD QUALITY EXAMINATION AND
DIAGNOSIS

DSS


3 PHASES IN

DHF
DANGER

FEVER

RECOVER

Day

Clinical

Pl. leaks
Testings

ELISA

virus

WARNINGS

NGAY
Temp.

Sốc/XH
MODS

Hypervolumia



DHF COMPLICATED WITH ACUTE
HEPATIC DYSFUNCTION
DHF WITH LIVER DYSFUNCTION

AST, ALT

MILD

120 - < 400U/L.

MODERATE

400 - < 1000U/L.

SEVERE (ACUTE LIVER
FAILURE)

≥ 1000U/L, or
Hepatic
encephalopathy
(HE)


DHF CLASSIFICATIONS
classifications

SXHD

Epidemics cause
Fever ≤ 7 days and 2 of
the following:
- Nausea, vomiting
.- Rash.
- Myalgia, arthralgia,
sore eyes
.- Skin bleeding or
Tourniquet test (+)
.- Normal or increased
Clinical and hct
laboratory .- Normal or decreased
findings white blood cell count
.- Normal platelet or
Thrombocytopenia

SXHD có dấu hiệu cảnh báo

At least 1 of the following:

lethargy, drowsiness
.- severe pain abdomen
.- Vomitting≥ 3 times/hrs or
≥ 4 times/6hrs
.- Abnormal bleedings
.- Hepatomegaly
.- Oligouria
.- Hct ↑↑↑ or PLT ↓↓.
- AST/ALT ≥ 400U/L*
.- Pleural/ Abdominal
effusion

SXHD nặng

At least 1 of the
following:
1. Plasma leakage
2. Critical bleedings
3. MODS
- Liver: AST or ALT ≥
1000U/L
.- Alterd mental status
- Heart and other organs

DHF WITH WARNINGS (2019 GUIDELINE)


DHF TESTINGS
IgG

IgG

IgM
NS1

Viral RT-PCR

DAYS
1

2

3

4

5

6

7

8

9

10


III. PEDIATRIC DHF TREATMENT

PEDIATRIC DHF TREATMENT

DHF

DHF WITH
WARNINGS

DSS

• Oral
rehydration
• Observations

• ADMISSION
• hydration
with IV fluids

• CRITICAL
CARE WITH
FLUID, MV, …


1. PEDIATRIC DHF TREATMENTS
Outpatient Treatment:
• oral rehydration solution→ prevent
dehydration
• Antipyretic: Acetaminophen 10-15mg/kg q6-8h
• Bed rest

• Close observations to find out warnings
IV Fluid is not recommended


2. TREATMENT FOR DHF WITH WARNINGS

1. Oral rehydration
2. Initiate IV infusion with Hartmann’s at 67ml/kg/hr - if needed,
3. Time duration for IV about 24hrs
4. Perform patient and Hematocrit assessment
each 4-6hrs
5. Early shock recognition and management


PEDIATRIC VITAL SIGNS
NORMAL RANGES
YS OLD

RR
(bpm)

HR
(bpm)

SBP
(mmHg)



KEY IN DHF WITH WARNINGS TREATMENT:

ORAL REHYDRATION AND/ OR IV FLUID
COMPENSATION IF NEEDED


1

4

3
2


1

4

3
2