Response to volume resuscitation in children with severe malaria*

Abstract

Volume depletion is present at admission in the majority of children with severe malaria complicated by acidosis. Volume expansion corrects the hemodynamic abnormalities and is associated with improved organ function and reduction in acidosis. Formal trials of volume expansion are needed to determine whether volume expansion will reduce mortality.

Phase II trial on the use of Dextran 70 or starch for supportive therapy in Kenyan children with severe malaria*

“…In a series of trials we have established that fluid resuscitation with 5% human albumin solution (HAS) results in a lower mortality than either 0.9% saline or Gelofusine ® (a gelatin polymer) [3,10,15,16]. The greatest benefit was seen in the high risk group with acidosis and coma [10].…”

“…We have previously hypothesised that acidosis in severe malaria is due in part to impaired perfusion (or hypovolaemia) [3,[8][9][10]. We have generated, together with others, new clear evidence indicating that volume depletion contributes to the pathophysiology of severe malaria and that volume expansion, the usual treatment of hypovolaemia, is safe and may improve outcome [3,10]. Nevertheless, there remains considerable debate over whether volume depletion contributes to the pathophysiology in children with severe malaria; with anxieties expressed that volume expansion may result in more harm than benefit [8,11,12].…”

“…Amongst the physiological derangements associated with severe, life-threatening malaria, metabolic acidosis has emerged as a central feature, being widely recognised as the best independent predictor of death in both children and adults [2][3][4][5].The highest mortality occurs in children presenting in deep coma with metabolic acidosis [6,7]. We have previously hypothesised that acidosis in severe malaria is due in part to impaired perfusion (or hypovolaemia) [3,[8][9][10]. We have generated, together with others, new clear evidence indicating that volume depletion contributes to the pathophysiology of severe malaria and that volume expansion, the usual treatment of hypovolaemia, is safe and may improve outcome [3,10].…”

“…For children developing severe and complicated Plasmodium falciparum malaria case fatality on current treatment remains high [1]. Amongst the physiological derangements associated with severe, life-threatening malaria, metabolic acidosis has emerged as a central feature, being widely recognised as the best independent predictor of death in both children and adults [2][3][4][5].The highest mortality occurs in children presenting in deep coma with metabolic acidosis [6,7]. We have previously hypothesised that acidosis in severe malaria is due in part to impaired perfusion (or hypovolaemia) [3,[8][9][10].…”

What’s New in the Recognition and Management of Septic Shock in Children: Dos and Don'ts

“…In a recent study of patients with fluid resistant (who required 40 mL/kg or more of resuscitation) septic shock [27], patients with central-line-associated infection (predominantly Staphylococcus epidermidis and Klebsiella pneumoniae) presented with high cardiac output and low systemic vascular resistance while patients with community acquired sepsis presented with low or normal cardiac output and high systemic vascular resistance. Furthermore, the clinical picture of ''septic shock'' can occur in response to a wide range of pathogens including viruses [28][29][30], malaria [31], rickettsiae and a range of bacterial pathogens.…”