Associations Between Restrictive Fluid Management and Renal Function and Tissue Perfusion in Adults With Severe Falciparum Malaria: A Prospective Observational Study
<br><strong>Background: </strong>Liberal fluid resuscitation has proved harmful in adults with severe malaria, but the level of restriction has not been defined.</br> <br><strong>Methods: </strong>In a prospective observational study in adults with severe f...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Oxford University Press
2019
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| _version_ | 1826275643150565376 |
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| author | Ishioka, H Plewes, K Pattnaik, R Kingston, HWF Leopold, SJ Herdman, MT Mahanta, K Mohanty, A Dey, C Alam, S Srinamon, K Mohanty, A Maude, RJ White, NJ Day, NPJ Hossain, MA Faiz, MA Charunwatthana, P Mohanty, S Ghose, A Dondorp, AM |
| author_facet | Ishioka, H Plewes, K Pattnaik, R Kingston, HWF Leopold, SJ Herdman, MT Mahanta, K Mohanty, A Dey, C Alam, S Srinamon, K Mohanty, A Maude, RJ White, NJ Day, NPJ Hossain, MA Faiz, MA Charunwatthana, P Mohanty, S Ghose, A Dondorp, AM |
| author_sort | Ishioka, H |
| collection | OXFORD |
| description | <br><strong>Background: </strong>Liberal fluid resuscitation has proved harmful in adults with severe malaria, but the level of restriction has not been defined.</br>
<br><strong>Methods: </strong>In a prospective observational study in adults with severe falciparum malaria, restrictive fluid management was provided at the discretion of the treating physician. The relationships between the volume of fluid and changes in renal function or tissue perfusion were evaluated.</br>
<br><strong>Results: </strong>A total of 154 patients were studied, 41 (26.6%) of whom died. Median total fluid intake during the first 6 and 24 hours from enrollment was 3.3 (interquartile range [IQR], 1.8–5.1) mL/kg per hour and 2.2 (IQR, 1.6–3.2) mL/kg per hour, respectively. Total fluid intake at 6 hours was not correlated with changes in plasma creatinine at 24 hours (n = 116; rs = 0.16; P = .089) or lactate at 6 hours (n = 94; rs = −0.05; P = .660). Development of hypotensive shock or pulmonary edema within 24 hours after enrollment were not related to the volume of fluid administration.</br>
<br><strong>Conclusions: </strong>Restrictive fluid management did not worsen kidney function and tissue perfusion in adult patients with severe falciparum malaria. We suggest crystalloid administration of 2–3 mL/kg per hour during the first 24 hours without bolus therapy, unless the patient is hypotensive.</br> |
| first_indexed | 2024-03-06T23:01:53Z |
| format | Journal article |
| id | oxford-uuid:626aa592-a8fd-4478-a838-a84ff746bb94 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T23:01:53Z |
| publishDate | 2019 |
| publisher | Oxford University Press |
| record_format | dspace |
| spelling | oxford-uuid:626aa592-a8fd-4478-a838-a84ff746bb942022-03-26T18:06:12ZAssociations Between Restrictive Fluid Management and Renal Function and Tissue Perfusion in Adults With Severe Falciparum Malaria: A Prospective Observational StudyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:626aa592-a8fd-4478-a838-a84ff746bb94EnglishSymplectic ElementsOxford University Press 2019Ishioka, HPlewes, KPattnaik, RKingston, HWFLeopold, SJHerdman, MTMahanta, KMohanty, ADey, CAlam, SSrinamon, KMohanty, AMaude, RJWhite, NJDay, NPJHossain, MAFaiz, MACharunwatthana, PMohanty, SGhose, ADondorp, AM<br><strong>Background: </strong>Liberal fluid resuscitation has proved harmful in adults with severe malaria, but the level of restriction has not been defined.</br> <br><strong>Methods: </strong>In a prospective observational study in adults with severe falciparum malaria, restrictive fluid management was provided at the discretion of the treating physician. The relationships between the volume of fluid and changes in renal function or tissue perfusion were evaluated.</br> <br><strong>Results: </strong>A total of 154 patients were studied, 41 (26.6%) of whom died. Median total fluid intake during the first 6 and 24 hours from enrollment was 3.3 (interquartile range [IQR], 1.8–5.1) mL/kg per hour and 2.2 (IQR, 1.6–3.2) mL/kg per hour, respectively. Total fluid intake at 6 hours was not correlated with changes in plasma creatinine at 24 hours (n = 116; rs = 0.16; P = .089) or lactate at 6 hours (n = 94; rs = −0.05; P = .660). Development of hypotensive shock or pulmonary edema within 24 hours after enrollment were not related to the volume of fluid administration.</br> <br><strong>Conclusions: </strong>Restrictive fluid management did not worsen kidney function and tissue perfusion in adult patients with severe falciparum malaria. We suggest crystalloid administration of 2–3 mL/kg per hour during the first 24 hours without bolus therapy, unless the patient is hypotensive.</br> |
| spellingShingle | Ishioka, H Plewes, K Pattnaik, R Kingston, HWF Leopold, SJ Herdman, MT Mahanta, K Mohanty, A Dey, C Alam, S Srinamon, K Mohanty, A Maude, RJ White, NJ Day, NPJ Hossain, MA Faiz, MA Charunwatthana, P Mohanty, S Ghose, A Dondorp, AM Associations Between Restrictive Fluid Management and Renal Function and Tissue Perfusion in Adults With Severe Falciparum Malaria: A Prospective Observational Study |
| title | Associations Between Restrictive Fluid Management and Renal Function and Tissue Perfusion in Adults With Severe Falciparum Malaria: A Prospective Observational Study |
| title_full | Associations Between Restrictive Fluid Management and Renal Function and Tissue Perfusion in Adults With Severe Falciparum Malaria: A Prospective Observational Study |
| title_fullStr | Associations Between Restrictive Fluid Management and Renal Function and Tissue Perfusion in Adults With Severe Falciparum Malaria: A Prospective Observational Study |
| title_full_unstemmed | Associations Between Restrictive Fluid Management and Renal Function and Tissue Perfusion in Adults With Severe Falciparum Malaria: A Prospective Observational Study |
| title_short | Associations Between Restrictive Fluid Management and Renal Function and Tissue Perfusion in Adults With Severe Falciparum Malaria: A Prospective Observational Study |
| title_sort | associations between restrictive fluid management and renal function and tissue perfusion in adults with severe falciparum malaria a prospective observational study |
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