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Malaria requiring intensive care

K L Khoo1, W L Tan, P Eng

  • 1Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.

Annals of the Academy of Medicine, Singapore
|October 20, 1998
PubMed
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This study analyzed 24 adult malaria patients in intensive care, finding severe falciparum malaria complications like kidney failure and respiratory support needs. The actual intensive care mortality was 12.5%, lower than the predicted 18.7% by APACHE II score.

Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Tropical Medicine

Background:

  • Malaria remains a significant global health concern, particularly severe Plasmodium falciparum malaria.
  • Intensive care unit (ICU) admission for malaria patients indicates severe disease with high complication rates.
  • Accurate prognostication is crucial for managing severe malaria cases in critical care settings.

Purpose of the Study:

  • To characterize the clinical features, complications, treatment, and outcomes of adult malaria patients requiring intensive care.
  • To compare the actual mortality with predicted mortality using the APACHE II score in this patient cohort.
  • To identify specific complications associated with severe falciparum malaria in critically ill patients.

Main Methods:

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  • Retrospective analysis of 24 adult malaria patients admitted to the intensive care unit (ICU) over a 4-year period.
  • Data collection included patient demographics, travel history, malaria type, clinical presentation, complications, treatments (including blood product transfusions and mechanical ventilation), and outcomes.
  • APACHE II (Acute Physiology and Chronic Health Evaluation II) scores were calculated to predict mortality.

    • Main Results:

    • Severe falciparum malaria was the predominant type (20/24 patients), often imported.
    • Major complications included acute dialysis (9 patients) and mechanical ventilation (8 patients).
    • The ICU mortality rate was 12.5% (3/24), with a 15% mortality for severe falciparum malaria, which was lower than the predicted APACHE II mortality of 18.7%.

    Conclusions:

    • Critically ill malaria patients, especially those with severe falciparum malaria, experience significant complications requiring intensive care interventions.
    • The APACHE II score may overestimate mortality in this specific malaria ICU population.
    • Effective management in intensive care settings can lead to better outcomes than predicted by standard scoring systems.