Experiences with severe P. falciparum malaria in the intensive care unit.
OBJECTIVE
To review the clinical profiles and therapies instituted for patients with severe malaria admitted to an ICU.


METHODS
Retrospective study.


METHODS
Internal ICU of a tertiary care centre.


METHODS
Between January, 1992, and February, 1999, 104 patients with malaria were admitted to the General Hospital of Vienna. Sixty-nine patients suffered from Plasmodium falciparum malaria (66%), seven of these were admitted to the ICU.


RESULTS
Seven patients were admitted to the ICU, of whom three died (4% in hospital case-fatality rate). Four patients required mechanical ventilation because of respiratory insufficiency and adult respiratory distress syndrome (ARDS), of whom three died. Three patients were treated with inhaled nitric oxide (NO) and kinetic therapy; one patient required extracorporeal veno-venous oxygenation. All patients who died required haemofiltration because of acute renal failure.


CONCLUSIONS
As P. falciparum is a potentially life-threatening disease, reliable criteria for ICU admission should be defined and risk factors identified. Early ICU monitoring should be attempted, especially under the following conditions: (1) lack of clinical response to anti-malarial treatment within 48 h and/or (2) any signs of neurological disturbance (hypoglycaemia excluded). Prospective multicentre trials and guidelines for supportive intensive care are urgently needed.
Losert
H
H
Department of Internal Medicine I, University Hospital of Vienna, Austria.
Schmid
K
K
Wilfing
A
A
Winkler
S
S
Staudinger
T
T
Kletzmayr
J
J
Burgmann
H
H
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000962:Antimalarials / Q000627:therapeutic use; D002423:Cause of Death; D002981:Clindamycin / Q000627:therapeutic use; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016778:Malaria, Falciparum / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011803:Quinine / Q000627:therapeutic use; D012121:Respiration, Artificial; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D000962:Antimalarials; D002981:Clindamycin; D011803:Quinine