Need-based Compared to Guidelines-based Fluid Administration in Dengue Patients with Warning Signs: An Open-label Randomized Study.

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.