Publication: Central venous catheter use in severe malaria: time to reconsider the World Health Organization guidelines?
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2011-11-14
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2011-11-14
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2011
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eng
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1475-2875 (electronic)
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BioMed Central
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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.
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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 Central venous catheter use in severe malaria: time to reconsider the World Health Organization guidelines?. 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.. doi:10.1186/1475-2875-10-342 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/817
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Central venous catheter use in severe malaria: time to reconsider the World Health Organization guidelines?
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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.