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Title: Central venous catheter use in severe malaria: Time to reconsider the World Health Organization guidelines?
Authors: Josh Hanson
Sophia Wk Lam
Sanjib Mohanty
Shamshul Alam
Md Mahtab Hasan
Sue J. Lee
Marcus J. Schultz
Prakaykaew Charunwatthana
Sophie Cohen
Ashraf Kabir
Saroj Mishra
Nicholas Pj Day
Nicholas J. White
Arjen M. Dondorp
Cairns Base Hospital
Mahidol University
Ispat General Hospital
Chittagong Medical College Hospital
Academic Medical Centre, University of Amsterdam
Cox's Bazar Medical College
Nuffield Department of Clinical Medicine
Keywords: Immunology and Microbiology;Medicine
Issue Date: 17-Nov-2011
Citation: Malaria Journal. Vol.10, (2011)
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 cmH 2 O. 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 thermodilutio n. 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 cmH 2 O in adults with severe malaria, should be reconsidered. © 2011 Hanson et al; licensee BioMed Central Ltd.
ISSN: 14752875
Appears in Collections:Scopus 2011-2015

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