A retrospective analysis of the haemodynamic and metabolic effects of fluid resuscitation in Vietnamese adults with severe falciparum malaria.
BACKGROUND
Optimising the fluid resuscitation of patients with severe malaria is a simple and potentially cost-effective intervention. Current WHO guidelines recommend central venous pressure (CVP) guided, crystalloid based, resuscitation in adults.


METHODS
Prospectively collected haemodynamic data from intervention trials in Vietnamese adults with severe malaria were analysed retrospectively to assess the responses to fluid resuscitation.


RESULTS
43 patients were studied of whom 24 received a fluid load. The fluid load resulted in an increase in cardiac index (mean increase: 0.75 L/min/m(2) (95% Confidence interval (CI): 0.41 to 1.1)), but no significant change in acid-base status post resuscitation (mean increase base deficit 0.6 mmol/L (95% CI: -0.1 to 1.3). The CVP and PAoP (pulmonary artery occlusion pressure) were highly inter-correlated (r(s) = 0.7, p<0.0001), but neither were correlated with acid-base status (arterial pH, serum bicarbonate, base deficit) or respiratory status (PaO(2)/FiO(2) ratio). There was no correlation between the oxygen delivery (DO(2)) and base deficit at the 63 time-points where they were assessed simultaneously (r(s) = -0.09, p = 0.46).


CONCLUSIONS
In adults with severe falciparum malaria there was no observed improvement in patient outcomes or acid-base status with fluid loading. Neither CVP nor PAoP correlated with markers of end-organ perfusion or respiratory status, suggesting these measures are poor predictors of their fluid resuscitation needs.
Hospital of Tropical Diseases, Ho Chi Minh City, Vietnam. phunh@oucru.org
Hoan Phu
HP
Nguyen
Josh
J
Hanson
Delia
D
Bethell
Thi Hoang Mai
TH
Nguyen
Thi Hong Chau
TH
Tran
Van Chuong
VC
Ly
Phu Loc
PL
Pham
Xuan Sinh
XS
Dinh
Arjen
A
Dondorp
Nicholas
N
White
Tinh Hien
TH
Tran
Nicholas
N
Day
D000136:Acid-Base Equilibrium / Q000187:drug effects; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D003710:Demography; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D015532:Rehydration Solutions / Q000494:pharmacology / Q000627:therapeutic use; D012189:Retrospective Studies; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D014744:Vietnam
D015532:Rehydration Solutions