Publication: Central venous catheter use in severe malaria: Time to reconsider the World Health Organization guidelines?
Issued Date
2011-11-17
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ISSN
14752875
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2-s2.0-81055150468
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Mahidol University
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SCOPUS
Bibliographic Citation
Malaria Journal. Vol.10, (2011)
Suggested Citation
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 Central venous catheter use in severe malaria: Time to reconsider the World Health Organization guidelines?. Malaria Journal. Vol.10, (2011). doi:10.1186/1475-2875-10-342 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/11964
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Title
Central venous catheter use in severe malaria: Time to reconsider the World Health Organization guidelines?
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.