Need-based Compared to Guidelines-based Fluid Administration in Dengue Patients with Warning Signs: An Open-label Randomized Study.
- 1Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
- 2Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Abstract
Introduction
Fluid therapy is fundamental in dengue management. We evaluated an individualized, hemodynamic parameter-guided fluid strategy compared with standard World Health Organization (WHO) guideline-based care in dengue patients with warning signs.Methods
In this open-label randomized controlled trial conducted at a tertiary care hospital in New Delhi (December 2019-October 2023), 80 adult dengue patients with warning signs were randomized (1:1) to receive either WHO guideline-based fluid therapy (control) or need-based therapy guided by noninvasive cardiac output monitoring (NICOM) and point-of-care ultrasound (POCUS) (intervention). The primary outcome was hemodynamic stability assessed by systolic blood pressure (SBP), pulse pressure (PP), and mean arterial pressure over 48 h. Secondary outcomes included hospital stay, progression to severe dengue, and mortality.Results
Baseline characteristics were comparable across groups. The intervention arm demonstrated higher mean PP at 8 h (45.2 ± 11.6 mmHg vs. 39.8 ± 8.7 mmHg), 12 h (45 ± 11.3 mmHg vs. 38.9 ± 8.1 mmHg), and 24 h (44.1 ± 9.6 mmHg vs. 39.1 ± 6.6 mmHg) (P < 0.05). SBP was higher at 8 h (P = 0.02). However, progression to severe dengue (17.5% in both groups), hospital stay (5.4 vs. 5.5 days; P = 0.87), and mortality (none) were similar.Conclusion
Although NICOM/POCUS-guided fluid therapy improved selected hemodynamic parameters, it did not translate into measurable improvements in clinical outcomes compared with WHO guideline-based care. Larger, multicenter studies powered for clinical endpoints in high-risk subgroups are warranted.
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BibTeX
@article{soneja2026needbased,
title = {{Need-based Compared to Guidelines-based Fluid Administration in Dengue Patients with Warning Signs: An Open-label Randomized Study.}},
author = {Manish Soneja and Paras Singla and Chaitanya and Ayush Agarwal and Adil Rashid Khan and Neeraj Nischal and Upendra Baitha and Pankaj Jorwal and Animesh Ray and Ashutosh Biswas and Naveet Wig},
journal = {Journal of global infectious diseases},
year = {2026},
month = jul,
doi = {10.4103/jgid.jgid_202_25},
url = {https://europepmc.org/article/MED/42899050},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Need-based Compared to Guidelines-based Fluid Administration in Dengue Patients with Warning Signs: An Open-label Randomized Study.
AU - Manish Soneja
AU - Paras Singla
AU - Chaitanya
AU - Ayush Agarwal
AU - Adil Rashid Khan
AU - Neeraj Nischal
AU - Upendra Baitha
AU - Pankaj Jorwal
AU - Animesh Ray
AU - Ashutosh Biswas
AU - Naveet Wig
PY - 2026
DA - 2026/07/01
JO - Journal of global infectious diseases
DO - 10.4103/jgid.jgid_202_25
UR - https://europepmc.org/article/MED/42899050
AB - Introduction Fluid therapy is fundamental in dengue management. We evaluated an individualized, hemodynamic parameter-guided fluid strategy compared with standard World Health Organization (WHO) guideline-based care in dengue patients with warning signs.Methods In this open-label randomized controlled trial conducted at a tertiary care hospital in New Delhi (December 2019-October 2023), 80 adult dengue patients with warning signs were randomized (1:1) to receive either WHO guideline-based fluid therapy (control) or need-based therapy guided by noninvasive cardiac output monitoring (NICOM) and point-of-care ultrasound (POCUS) (intervention). The primary outcome was hemodynamic stability assessed by systolic blood pressure (SBP), pulse pressure (PP), and mean arterial pressure over 48 h. Secondary outcomes included hospital stay, progression to severe dengue, and mortality.Results Baseline characteristics were comparable across groups. The intervention arm demonstrated higher mean PP at 8 h (45.2 ± 11.6 mmHg vs. 39.8 ± 8.7 mmHg), 12 h (45 ± 11.3 mmHg vs. 38.9 ± 8.1 mmHg), and 24 h (44.1 ± 9.6 mmHg vs. 39.1 ± 6.6 mmHg) (P < 0.05). SBP was higher at 8 h (P = 0.02). However, progression to severe dengue (17.5% in both groups), hospital stay (5.4 vs. 5.5 days; P = 0.87), and mortality (none) were similar.Conclusion Although NICOM/POCUS-guided fluid therapy improved selected hemodynamic parameters, it did not translate into measurable improvements in clinical outcomes compared with WHO guideline-based care. Larger, multicenter studies powered for clinical endpoints in high-risk subgroups are warranted.
SN - 0974-777X
SN - 0974-8245
ER -