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...

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Bibliographic Details
Published in:Malaria Journal
Main Authors: Hanson Josh, Lam Sophia WK, Mohanty Sanjib, Alam Shamshul, Hasan Md Mahtab, Lee Sue J, Schultz Marcus J, Charunwatthana Prakaykaew, Cohen Sophie, Kabir Ashraf, Mishra Saroj, Day Nicholas PJ, White Nicholas J, Dondorp Arjen M
Format: Article in Journal/Newspaper
Language:English
Published: BMC 2011
Subjects:
Arctic medicine. Tropical medicine
RC955-962
Infectious and parasitic diseases
RC109-216
Arctic
Indian
Online Access:https://doi.org/10.1186/1475-2875-10-342
https://doaj.org/article/3f60c971379f4b7ba0ff0d4317524173
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Summary: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 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 cmH 2 O in adults with severe malaria, should be reconsidered.

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