title: Managing malaria in the intensive care unit.
abstract: The number of people travelling to malaria-endemic countries continues to increase, and malaria remains the commonest cause of serious imported infection in non-endemic areas. Severe malaria, mostly caused by Plasmodium falciparum, often requires intensive care unit (ICU) admission and can be complicated by cerebral malaria, respiratory distress, acute kidney injury, bleeding complications, and co-infection. The mortality from imported malaria remains significant. This article reviews the manifestations, complications and principles of management of severe malaria as relevant to critical care clinicians, incorporating recent studies of anti-malarial and adjunctive treatment. Effective management of severe malaria includes prompt diagnosis and early institution of effective anti-malarial therapy, recognition of complications, and appropriate supportive management in an ICU. All cases should be discussed with a specialist unit and transfer of the patient considered.
authors.affiliation: The Hospital for Tropical Diseases, Mortimer Market Centre, Capper Street, London, UK Department of Clinical Research, Faculty of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Marks
authors.affiliation: The Hospital for Tropical Diseases, Mortimer Market Centre, Capper Street, London, UK Department of Clinical Research, Faculty of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Gupta-Wright
authors.affiliation: The Hospital for Tropical Diseases, Mortimer Market Centre, Capper Street, London, UK.
authors.forename: J F
authors.initials: JF
authors.lastname: Doherty
authors.affiliation: Department of Critical Care, University College London Hospital NHS Foundation Trust, 3rd Floor, 235 Euston Road, London NW1 2BU, UK.
authors.forename: M
authors.initials: M
authors.lastname: Singer
authors.affiliation: Department of Critical Care, University College London Hospital NHS Foundation Trust, 3rd Floor, 235 Euston Road, London NW1 2BU, UK david.walker@uclh.nhs.uk.
authors.forename: D
authors.initials: D
authors.lastname: Walker
mesh_terms: D000465:Algorithms; D000962:Antimalarials / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods*; D003937:Diagnosis, Differential; D005078:Exchange Transfusion, Whole Blood / Q000379:methods; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D007362:Intensive Care Units; D008288:Malaria / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D016778:Malaria, Falciparum / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D011379:Prognosis; D014195:Travel
chemical_list: D000962:Antimalarials
keywords: ARDS; ICU; imported infections; malaria