Serial bedside echocardiography identifies children at risk of recurrent Dengue shock: a prospective cohort study

Dengue shock syndrome (DSS) is characterised by vascular leakage, although myocardial impairment may contribute to haemodynamic instability. The dynamic interplay between volume depletion and cardiac function during resuscitation remains incompletely understood. We conducted a prospective cohort study of children aged 6–15 years with DSS admitted to Hospital for Tropical Diseases in Ho Chi Minh City (2018–2020). Serial bedside echocardiography was performed at shock presentation and at 1, 3, 6, 12, and 24 h post-resuscitation, daily until hospital discharge, at follow-up 1–2 weeks later, and during recurrent shock. 90 patients were enrolled; 16 (18%) developed recurrent shock at a median of 14 (IQR 11–17) hours after initial resuscitation. During shock, reduced SVI and CI during shock occurred in the presence of preserved LVEF and small IVC diameters, consistent with a preload-limited state. Transient myocardial impairment (MPI > 0.45) occurred in 40 patients (44%), and improved with fluid replacement. At 6 hours after resuscitation, patients who subsequently developed recurrent shock showed distinct haemodynamic profiles, including higher heart rate, lower SVI, lower lateral e′ velocity, higher E/e’, and lower TAPSE. Reduced lateral e’ velocity was also associated with respiratory distress. In DSS, preload reduction due to vascular leakage appears to be a major contributor to recurrent shock, although transient myocardial involvement may coexist. Focused echocardiographic assessment 6 h after resuscitation may help identify children at risk of recurrent shock before overt deterioration, supporting earlier risk stratification and more targeted fluid management. In dengue shock syndrome, hypovolaemia is the main cause of recurrent shock, though transient myocardial involvement may also contribute. Echocardiographic measures, including stroke volume index, lateral e′ velocity, E/e′ ratio, and TAPSE, assessed six hours after resuscitation can identify children at risk before clinical deterioration. Combined with vital sign monitoring, these parameters enhance early recognition and guide targeted, personalised fluid management.