Point-of-care ultrasound to assess volume status and pulmonary oedema in malaria patients

Abstract

Purpose Fluid management is challenging in malaria patients given the risks associated with intravascular fluid depletion and iatrogenic fluid overload leading to pulmonary oedema. Given the limitations of the physical examination in guiding fluid therapy, we evaluated point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) and lungs as a novel tool to assess volume status and detect early oedema in malaria patients. Methods To assess the correlation between IVC and lung ultrasound (LUS) indices and clinical signs of hypovolaemia and pulmonary oedema, respectively, concurrent clinical and sonographic examinations were performed in an observational study of 48 malaria patients and 62 healthy participants across age groups in Gabon. Results IVC collapsibility index (CI) ≥ 50% on enrolment reflecting intravascular fluid depletion was associated with an increased number of clinical signs of hypovolaemia in severe and uncomplicated malaria. With exception of dry mucous membranes, IVC-CI correlated with most clinical signs of hypovolaemia, most notably sunken eyes (r = 0.35, p = 0.0001) and prolonged capillary refill (r = 0.35, p = 0.001). IVC-to-aorta ratio ≤ 0.8 was not associated with any clinical signs of hypovolaemia on enrolment. Among malaria patients, a B-pattern on enrolment reflecting interstitial fluid was associated with dyspnoea (p = 0.0003), crepitations and SpO2 ≤ 94% (both p < 0.0001), but not tachypnoea (p = 0.069). Severe malaria patients had increased IVC-CI (p < 0.0001) and more B-patterns (p = 0.004) on enrolment relative to uncomplicated malaria and controls. Conclusion In malaria patients, POCUS of the IVC and lungs may improve the assessment of volume status and detect early oedema, which could help to manage fluids in these patients.

A survey of barriers and facilitators to ultrasound use in low- and middle-income countries

“…With the advent of the COVID-19 pandemic, we have witnessed increased interest and literature around the role of point-of-care ultrasound 35,36 . Use cases with special relevance to LMIC settings include diagnosis and management of infectious diseases such as malaria, tuberculosis, dengue, schistosomiasis, leishmaniasis, and cystic echinococcosis 11,[37][38][39][40][41][42][43][44][45] . In our survey, respondents reported using ultrasound most frequently for procedures; other common applications included evaluations on the lungs, heart/echocardiography, and focused assessments for trauma.…”

Task shifting for point of care ultrasound in primary healthcare in low- and middle-income countries-a systematic review

“…The study from Morocco on POCUS screening for cystic echinococcosis (CE) 22 an infectious disease with a primarily imaging-based diagnosis, 86 proved not only feasible and successful in identifying the disease, but is a good example that POCUS can also support the implementation of disease control activities. POCUS for the detection of urogenital schistosomiasis, 49 POCUS to guide management of severe malaria, 87 POCUS for early detection of vascular leakage in severe dengue 88 and POCUS for visceral leishmaniasis 89,90 FAST: focused assessment with sonography for trauma, FASH: focused assessment with sonography for HIV-associated tuberculosis, FASE: focused assessment with sonography for echinococcosis.…”

Point‐of‐care ultrasound needs assessment in a paediatric acute care setting in Malawi

“…POCUS is an inexpensive, clinician‐performed imaging method that can directly impact patient care and benefit adult [3–8, 20, 21, 28] and paediatric [5, 29–33] patients in RLS. Training programmes in POCUS, however, must meet local needs and match local resources in order to be sustainable [9].…”