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Malaria: fluid therapy in severe disease
Susanne Helena Hodgson1, Brian John Angus
1University of Oxford, Oxford, UK.
Insights
Fluid resuscitation in severe malaria is complex. This systematic overview categorizes interventions like albumin, intravenous fluids, and blood products to guide optimal patient care and improve outcomes in this critical condition.
Area of Science:
- Medical Research
- Clinical Medicine
- Parasitology
Background:
- Severe malaria disproportionately affects vulnerable populations, including young children and non-immune individuals.
- Cerebral malaria presents a high mortality rate (around 20%) and can cause long-term neurological damage in survivors.
- Severe malarial anemia also carries a significant mortality risk exceeding 13%.
Purpose of the Study:
- To determine the optimal method of fluid resuscitation for patients diagnosed with severe malaria.
- To systematically review existing evidence on fluid management strategies in severe malaria.
Main Methods:
- A systematic overview was conducted, searching major medical databases up to December 2014.
- The review included screening 93 records, with 11 full publications undergoing detailed evaluation.
- GRADE methodology was applied to assess seven PICO (Population, Intervention, Comparison, Outcome) combinations.
Main Results:
- The search identified 187 studies, which were refined to 11 full articles for analysis.
- Two systematic reviews and three randomized controlled trials (RCTs) were newly incorporated in this update.
- A GRADE evaluation was performed for seven specific PICO scenarios.
Conclusions:
- The study categorized the efficacy of three key interventions: human albumin, intravenous fluids, and whole blood or plasma.
- This categorization aims to inform clinical decision-making regarding fluid resuscitation in severe malaria.
- The findings provide a basis for understanding the effectiveness and safety of different fluid management approaches.
Introduction:
Severe malaria mainly affects children aged under 5 years, non-immune travellers, migrants to malarial areas, and people living in areas with unstable or seasonal malaria. Cerebral malaria, causing encephalopathy and coma, is fatal in around 20% of children and adults, and may lead to neurological sequelae in survivors. Severe malarial anaemia may have a mortality rate of over 13%. The role of fluid resuscitation in severe malaria is complex and controversial. Volume expansion could help to improve impaired organ perfusion and correct metabolic acidosis. However, rapid volume expansion could aggravate intracranial hypertension associated with cerebral malaria, leading to an increased risk of cerebral herniation.
Methods And Outcomes:
We conducted a systematic overview, aiming to answer the following clinical question: What is the optimal method of fluid resuscitation in patients with severe malaria? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).
Results:
At this update, searching of electronic databases retrieved 187 studies. After deduplication and removal of conference abstracts, 93 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 82 studies and the further review of 11 full publications. Of the 11 full articles evaluated, two systematic reviews and three RCTs were added at this update. We performed a GRADE evaluation for seven PICO combinations.
Conclusions:
In this systematic overview, we categorised the efficacy for three interventions based on information about the effectiveness and safety of human albumin, intravenous fluids, and whole blood or plasma.
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