Equipment and Expert Care in LFHC's Intensive-Care-Unit Saves a Child with Severe Dengue

In early September, four-year-old Anyien arrived at Lao Friends Hospital for Children (LFHC) in distress. She was diagnosed with pneumonia and dengue fever (exhibiting warning signs affecting her blood).  Her condition rapidly declined, and she was admitted to the Intensive Care Unit (ICU) with dengue shock, the most severe manifestation of this disease that can lead to life-threatening complications and death.   Alongside this, she was battling disseminated intravascular coagulation (DIC), a condition where the components of blood that prevent bleeding were being consumed, placing her at even greater risk of bleeding.

Anyien’s lab tests revealed alarmingly low platelet levels—only 6,000 per microliter, far below the normal range of 150,000 to 450,000.  This drastic drop in platelets, along with DIC, made her susceptible to spontaneous bleeding, which unfortunately began to occur. To stabilize her condition, a central line was carefully placed, and the medical team commenced treatment following the LFHC dengue protocol, which was in alignment with World Health Organization (WHO) guidelines. Anyien was administered blood and platelets to replace her lost clotting ability.

Despite the initial interventions, Anyien’s situation worsened. By September 5th, she suffered respiratory failure as fluid filled her right lung, severely impeding her ability to breathe.  

The medical team promptly initiated treatment using a non-invasive positive pressure ventilator to help regulate her oxygen intake, along with diuretics to manage the excess fluid.

At one point, her oxygen saturation plummeted to a critical 60%, requiring a tube to be placed in her airway and placed on a ventilator.

The following morning X-ray confirmed that her lungs were completely filled with fluid, leading to acute respiratory distress syndrome (ARDS). This serious condition occurs when the lungs become fluid-filled, making breathing exceedingly difficult. Close monitoring and continuous support were crucial as Anyien fought for her life.

On September 7th, a glimmer of hope emerged. Anyien showed slight improvement, prompting the team to begin the delicate process of weaning her off the ventilator. They remained vigilant, providing necessary medications and support. By September 8th, she was successfully extubated and transitioned to Continuous Positive Airway Pressure (CPAP) therapy, which assisted her breathing while maintaining stable oxygen levels.

Through dedication and expert care, Anyien's condition steadily improved. By September 10th, she was stable, although she still faced hypothermia with a body temperature of 35 degrees Celsius (normal 37.4). The medical team focused on warming her, and their efforts paid off. Just two days later, Anyien was discharged a testament to the lifesaving care she received in the ICU.

The rainy season in Laos significantly impacts the transmission of dengue, as stagnant water creates ideal breeding grounds for mosquitoes. This seasonal uptick in mosquito activity contributes to a rise in dengue cases, highlighting the importance of timely and specialized medical care like that provided at LFHC.