Skip Navigation
Skip to contents

ACC : Acute and Critical Care

OPEN ACCESS
SEARCH
Search
Advanced Search
mobile menu button

Articles

Page Path
HOME > Acute Crit Care > Volume 40(4); 2025 > Article
Letter to the Editor
Infection Comment on “Excessive fluid resuscitation is associated with intensive care unit mortality in Pakistani patients with dengue shock syndrome”
Acute and Critical Care 2025;40(4):630-631.
DOI: https://doi.org/10.4266/acc.002875
Published online: November 24, 2025

1Private Academic Consultant, Phonhong, Laos

2Department of Community Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, India

Correspondence: Hinpetch Daungsupawong Private Academic Consultant, Lk52 Phonhong, Vientiane 10000, Laos Email: hinpetchdaung@gmail.com
• Received: May 25, 2025   • Revised: August 17, 2025   • Accepted: September 1, 2025

© 2025 The Korean Society of Critical Care Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • 555 Views
  • 14 Download
prev next
Full Article

Download PDF Download PDF

Dear Editor:
We read the article “Excessive fluid resuscitation is associated with intensive care unit mortality in Pakistani patients with dengue shock syndrome [1]” with interest. This study is critical for identifying the factors related to death in dengue shock syndrome (DSS) patients, particularly those who require intensive care. However, this study has some limitations that should be noted, including a retrospective study design, which is prone to data recording bias, and while Salahuddin et al. [1] utilized multivariable logistic regression to adjust for potential confounders, residual confounding may still exist due to unmeasured or unreported variables. Furthermore, there is no information on the timing of fluid administration or the phase of DSS (early resuscitation vs. late fluid overload), which could influence the interpretation of cumulative fluid balance.
Although the researchers used multivariate logistic regression to identify factors associated with mortality, other covariates that could have influenced the results were not reported, such as the time from symptom onset to admission, the type of fluid administered (crystalloid vs. colloid), and the type of vasopressor used [2]. Furthermore, the cut-off number used to divide cumulative fluid balance into three groups was arbitrary, and may not reflect genuine physiological differences. To achieve greater accuracy, a linear trend or spline model should be utilized.
Questions that still need to be addressed include: Is a cumulative fluid volume larger than 8 L simply a signal of serious disease or a direct cause of death? Can intensive fluid management measures based on hemodynamic markers or biomarkers (such as lactate clearance or extravascular lung water) help to lower the risk of fluid overload? And how do we transition from "aggressive resuscitation" to "goal-directed resuscitation" in DSS patients with multiple organ failure?
Future research should focus on prospective cohort studies or randomized controlled trials to better compare fluid management strategies at different stages of DSS, as well as the role of real-time fluid monitoring technologies like ultrasonography, bioimpedance analysis, and pulse contour analysis in developing the safest strategies for patients. Furthermore, long-term outcomes like as organ healing or quality of life following DSS survival are important areas of further investigation.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

FUNDING

None.

ACKNOWLEDGMENTS

The authors used a language editing computational tool (QuillBot) in the preparation of the article.

AUTHOR CONTRIBUTIONS

Conceptualization: HD, VW. Visualization: HD, VW. Writing - original draft: HD. Writing - review & editing: HD. All authors read and agreed to the published version of the manuscript.

  • 1. Salahuddin M, Khalid R, Hanif S, Naeem F, Aijaz R, Ali AS. Excessive fluid resuscitation is associated with intensive care unit mortality in Pakistani patients with dengue shock syndrome. Acute Crit Care 2025;40:235-43.ArticlePubMedPMCPDF
  • 2. Singh RK, Tiwari A, Satone PD, Priya T, Meshram RJ. Updates in the management of dengue shock syndrome: a comprehensive review. Cureus 2023;15:e46713. ArticlePubMedPMC

Figure & Data

References

    Citations

    Citations to this article as recorded by  

      • PubReader PubReader
      • ePub LinkePub Link
      • Cite
        CITE
        export Copy
        Close
        Download Citation
        Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
        Format:
        • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
        • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
        Include:
        • Citation for the content below
        Comment on “Excessive fluid resuscitation is associated with intensive care unit mortality in Pakistani patients with dengue shock syndrome”
        Acute Crit Care. 2025;40(4):630-631.   Published online November 24, 2025
        DOI: https://doi.org/10.4266/acc.002875
        Close
      • XML DownloadXML Download
      Related articles
      Comment on “Excessive fluid resuscitation is associated with intensive care unit mortality in Pakistani patients with dengue shock syndrome”
      Comment on “Excessive fluid resuscitation is associated with intensive care unit mortality in Pakistani patients with dengue shock syndrome”
      ACC : Acute and Critical Care
      © The Korean Society of Critical Care Medicine.
      TOP