Patients with severe dengue may have myocardial dysfunction in the form of decreased left ventricular ejection and cardiac index manifesting as hepatomegaly and tachycardia unresponsive to fluid therapy.These patients may respond to careful use of inotropic agents and vasodilators, after adequate fluid resuscitation.Myocardial dysfunction in dengue is transient and heart function usually returns to normal in survivors.
Patients who develop respiratory distress or failure because of shock or third spacing require oxygen and may benefit from nasal continuous positive airway pressure (NCPAP).Patients who deteriorate further with or without NCPAP, should be mechanically ventilated early. Patients with abdominal compartment syndrome will benefit from abdominal paracentesis.Occasionally, severe pleural effusions may require drainage with a small-bore catheter.