This protocol covers patients with severe dengue in compensated shock: systolic pressure is maintained, but signs of reduced perfusion persist — pulse pressure below 20 mmHg and raised haematocrit. Severe plasma leakage driving dengue shock and potential fluid accumulation with respiratory distress defines this presentation. The patient has already received a resuscitation attempt and has not met expected clinical targets.
Severe dengue with compensated shock — systolic pressure maintained alongside clear signs of reduced peripheral perfusion, pulse pressure below 20 mmHg, and raised haematocrit. This reflects severe plasma leakage that may lead to dengue shock and/or fluid accumulation with respiratory distress.
Initial fluid resuscitation — with crystalloid or colloid boluses, or blood product support where indicated — was administered. A second bolus was given without achieving the required clinical targets: blood pressure improvement, pulse pressure improvement, haematocrit decrease, improved urine output, and normalisation of pulse rate. This protocol defines the next step after that resuscitation strategy has been insufficient.
When hypotension persists after the second bolus, the protocol involves consideration of circulatory support alongside a structured diagnostic workup — to systematically exclude cardiogenic shock, septic shock, metabolic causes, and organ dysfunction before proceeding. The specific intervention, thresholds, and sequence are detailed in the full evidence-based regimen.