In dengue patients classified as moderately ill with warning signs — or those in a special, high-risk group — initial fluid management may not achieve the expected clinical recovery. This protocol addresses the escalation step for patients whose systolic pressure remains maintained but who continue to show signs of reduced perfusion and a raised haematocrit after fluid boluses.
Dengue with warning signs, or a special/high-risk population (comorbidity), presenting with systolic pressure maintained alongside clinical signs of reduced perfusion and raised haematocrit (Group B — moderately ill). This group includes all special populations and those with dengue warning signs.
The preceding management step used intravenous fluid boluses: crystalloid or colloid for a rising or high haematocrit (suspected ongoing capillary leakage), or blood transfusion and packed red blood cells when significant bleeding was suspected. The targets for that step were: improvement in blood pressure and pulse pressure, a decreasing haematocrit, adequate urine output, and improved capillary refilling.
This protocol is indicated when those targets have not been met after the second fluid bolus, and refractory hypotension persists.