Abstract
ABSTRACT: BACKGROUND: To optimize the fluid status of adult patients with severe malaria, World Health Organization (WHO) guidelines recommend the insertion of a central venous catheter (CVC) and a target central venous pressure (CVP) of 0-5 cmH2O. However there are few data from clinical trials to support this recommendation. METHODS: Twenty-eight adult Indian and Bangladeshi patients admitted to the intensive care unit with severe falciparum malaria were enrolled in the study. All patients had a CVC inserted and had regular CVP measurements recorded. The CVP measurements were compared with markers of disease severity, clinical endpoints and volumetric measures derived from transpulmonary thermodilution. RESULTS: There was no correlation between the admission CVP and patient outcome (p=0.67) or disease severity (p=0.33). There was no correlation between the baseline CVP and the concomitant extravascular lung water (p=0.62), global end diastolic volume (p=0.88) or cardiac index (p=0.44). There was no correlation between the baseline CVP and the likelihood of a patient being fluid responsive (p=0.37). On the occasions when the CVP was in the WHO target range patients were usually hypovolaemic and often had pulmonary oedema by volumetric measures. Seven of 28 patients suffered a complication of the CVC insertion, although none were fatal. CONCLUSION: The WHO recommendation for the routine insertion of a CVC, and the maintenance of a CVP of 0-5 cmH2O in adults with severe malaria, should be reconsidered
Original language | English |
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Pages (from-to) | 342 |
Journal | Malaria journal |
Volume | 10 |
Issue number | 1 |
DOIs | |
Publication status | Published - 2011 |