BACKGROUND: The role of volume resuscitation in severe Plasmodium falciparum malaria is controversial. AIM: To examine the role of hypovolaemia in severe childhood malaria. STUDY DESIGN: Retrospective review. METHODS: We studied 515 children admitted with severe malaria to a high-dependency unit (HDU) in Kilifi, Kenya. On admission to the HDU, children underwent a further assessment of vital signs and a standard clinical examination. RESULTS: Factors associated with a fatal outcome included deep breathing or acidosis (base excess below -8), hypotension (systolic blood pressure <80 mmHg), raised plasma creatinine (>80 micro mol/l), low oxygen saturation (<90%), dehydration and hypoglycaemia (<2.5 mmol/l). Shock was present in 212/372 (57%) children, of whom 37 (17.5%) died, and was absent in 160, of who only 7 (4.4%) died (chi(2) = 14.9; p = 0.001). DISCUSSION: Impaired tissue perfusion may play a role in the mortality of severe malaria. Moreover, volume resuscitation, an important life-saving intervention in children with hypovolaemia, should be considered in severe malaria with evidence of impaired tissue perfusion.
BACKGROUND: The role of volume resuscitation in severe Plasmodium falciparum malaria is controversial. AIM: To examine the role of hypovolaemia in severe childhood malaria. STUDY DESIGN: Retrospective review. METHODS: We studied 515 children admitted with severe malaria to a high-dependency unit (HDU) in Kilifi, Kenya. On admission to the HDU, children underwent a further assessment of vital signs and a standard clinical examination. RESULTS: Factors associated with a fatal outcome included deep breathing or acidosis (base excess below -8), hypotension (systolic blood pressure <80 mmHg), raised plasma creatinine (>80 micro mol/l), low oxygen saturation (<90%), dehydration and hypoglycaemia (<2.5 mmol/l). Shock was present in 212/372 (57%) children, of whom 37 (17.5%) died, and was absent in 160, of who only 7 (4.4%) died (chi(2) = 14.9; p = 0.001). DISCUSSION: Impaired tissue perfusion may play a role in the mortality of severe malaria. Moreover, volume resuscitation, an important life-saving intervention in children with hypovolaemia, should be considered in severe malaria with evidence of impaired tissue perfusion.
Authors: Charles R J C Newton; Clarissa Valim; Sanjeev Krishna; David Wypij; Christopher Olola; Tsiri Agbenyega; Terrie E Taylor Journal: Clin Infect Dis Date: 2005-08-23 Impact factor: 9.079
Authors: Brian M Greenwood; David A Fidock; Dennis E Kyle; Stefan H I Kappe; Pedro L Alonso; Frank H Collins; Patrick E Duffy Journal: J Clin Invest Date: 2008-04 Impact factor: 14.808
Authors: Susan Lewallen; Rachel N Bronzan; Nicholas A Beare; Simon P Harding; Malcolm E Molyneux; Terrie E Taylor Journal: Trans R Soc Trop Med Hyg Date: 2008-08-28 Impact factor: 2.184
Authors: Hamish Graham; Ayobami A Bakare; Adejumoke I Ayede; Oladapo B Oyewole; Amy Gray; David Peel; Barbara McPake; Eleanor Neal; Shamim A Qazi; Rasa Izadnegahdar; Trevor Duke; Adegoke G Falade Journal: EClinicalMedicine Date: 2019-10-24