Hemodynamic aspects and oxygenation variables in severe malaria of adults in Africa

Study of the hemodynamic profile and oxygenation variables in severe malaria to determine whether they are identical to those observed in severe bacterial infections.

Prospective study in an intensive care unit of a West African hospital.

Two groups of adult patients hospitalized for severe malaria according to WHO criteria, a control group (n = 13) with systemic vascular resistance of 800 dyne s(-1) cm(-5) or higher and a hyperkinetic group (n = 16) with a level lower than 800 dyne s(-1) cm(-5). Twenty-nine patients participated in this study (19 semi-immune, 10 nonimmune).

Before hemodynamic study a loading dose of quinine formiate was administered: 20 mg/ kg intravenously for 4 h. Artificial ventilation was used in the case of persistent hypoxemia.

The hemodynamic study with Swan-Ganz catheter was performed after filling with 1,000 ml lactated Ringer's solution. From a clinical and a biological standpoint there was no difference between the two groups except for creatine phosphokinase, which was significantly higher in the hyperkinetic group: 2404 +/- 3654 vs. 1,898 +/- 1,828 IU/l. Hemodynamic and oxygenation variables showed a significant difference in cardiac index (6.1 +/- 1.2 vs. 3.9 +/- 1.21 min(-1) m(-2)), systemic vascular resistance (536 +/- 143 vs. 1098 +/- 170 dyne s(-1) cm(-5)), oxygen delivery (645 +/- 163 vs. 482 +/- 186 ml min(-1) m(-2)), and oxygen extraction (23 +/- 9 % vs. 34 +/- 14 %). Oxygen extraction was negatively correlated with oxygen delivery in the control group but not in the hyperkinetic group. Eight of 10 nonimmune patients (80 %) were in the hyperkinetic group versus 8 of 19 semi-immune patients (42 %; p < 0.05). Nine patients in the hyperkinetic group (69 %) and seven of the control group (46 %) died (NS).

In contrast to severe bacterial infections, severe malaria does not always induce hyperkinetic-type hemodynamic changes. Such changes are observed mostly in nonimmune subjects.