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Please use this identifier to cite or link to this item: http://repository.li.mahidol.ac.th/dspace/handle/123456789/817
Title: Central venous catheter use in severe malaria: time to reconsider the World Health Organization guidelines?
Authors: Hanson, Josh
Lam, Sophia WK
Mohanty, Sanjib
Alam, Shamshul
Hasan, Md Mahtab Uddin
Lee, Sue J
Schultz, Marcus J
Prakaykaew Charunwatthana
ประกายแก้ว จรูญวรรธนะ
Cohen, Sophie
Kabir, Ashraf
Mishra, Saroj
Day, Nicholas PJ
White, Nicholas J
Dondorp, Arjen M
Mahidol University. Faculty of Tropical Medicine. Mahidol-Oxford Tropical Medicine Research Unit.
Hanson, Josh
Keywords: Malaria;Venous catheter;World Health Organization;Open Access article
Issue Date: 14-Nov-2011
Citation: Hanson J, Lam SW, Mohanty S, Alam S, Hasan MM, Lee SJ. et al. Central venous catheter use in severe malaria: time to reconsider the World Health Organization guidelines? Malar J. 2011 Nov 14;10:342.
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.
URI: http://repository.li.mahidol.ac.th/dspace/handle/123456789/817
metadata.dc.identifier.url: http://www.malariajournal.com/content/pdf/1475-2875-10-342.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228715/pdf/1475-2875-10-342.pdf
ISSN: 1475-2875 (electronic)
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