Central venous catheter use in severe malaria: time to reconsider the World Health Organization guidelines?

• 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

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.