Purpose: Fluid management is challenging in malaria patients given the risks associated with intravascular fluid depletion and iatrogenic fluid overload leading to pulmonary oedema. Given the limitations of the physical examination in guiding fluid therapy, we evaluated point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) and lungs as a novel tool to assess volume status and detect early oedema in malaria patients.
Methods: To assess the correlation between IVC and lung ultrasound (LUS) indices and clinical signs of hypovolaemia and pulmonary oedema, respectively, concurrent clinical and sonographic examinations were performed in an observational study of 48 malaria patients and 62 healthy participants across age groups in Gabon.
Results: IVC collapsibility index (CI) ≥ 50% on enrolment reflecting intravascular fluid depletion was associated with an increased number of clinical signs of hypovolaemia in severe and uncomplicated malaria. With exception of dry mucous membranes, IVC-CI correlated with most clinical signs of hypovolaemia, most notably sunken eyes (r = 0.35, p = 0.0001) and prolonged capillary refill (r = 0.35, p = 0.001). IVC-to-aorta ratio ≤ 0.8 was not associated with any clinical signs of hypovolaemia on enrolment. Among malaria patients, a B-pattern on enrolment reflecting interstitial fluid was associated with dyspnoea (p = 0.0003), crepitations and SpO2 ≤ 94% (both p < 0.0001), but not tachypnoea (p = 0.069). Severe malaria patients had increased IVC-CI (p < 0.0001) and more B-patterns (p = 0.004) on enrolment relative to uncomplicated malaria and controls.
Conclusion: In malaria patients, POCUS of the IVC and lungs may improve the assessment of volume status and detect early oedema, which could help to manage fluids in these patients.
Bibliographical noteFunding Information:
This study was supported in part by the Lazarus Scholars in Healthcare Delivery Program through the George Washington University and by the Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers.
We conducted a prospective proof-of-concept observational study of patients of all ages with malaria, with age-matched healthy volunteers as a control group. The study was conducted from September to December 2019 in Lambaréné, a town of approximately 39,000 inhabitants in Moyen-Ogooué Province of Gabon, in the Central African rainforest region. Patients were recruited from the paediatrics and internal medicine wards of the Albert Schweitzer Hospital (HAS), a 150-bed general hospital that serves the local population of Lambaréné and the surrounding villages. The hospital has both inpatient and outpatient services in emergency medicine, internal medicine, paediatrics, surgery and obstetrics/gynaecology. It operates as a private non-governmental organization (NGO) with joint funding from the Gabonese Ministry of Health.
© 2021, The Author(s).