Point-of-care ultrasound to assess volume status and pulmonary oedema in malaria patients.

Autor: Pugliese CM; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Infection and Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands.; School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA., Adegbite BR; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Infection and Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands.; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon., Edoa JR; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon., Mombo-Ngoma G; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon.; Institute for Tropical Medicine, German Center for Infection Research (DZIF), University of Tübingen, Tübingen, Germany.; Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Department of Medicine, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany., Obone-Atome FA; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon., Heuvelings CC; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Infection and Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands., Bélard S; Department of Paediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.; Berlin Institute of Health, Berlin, Germany., Kalkman LC; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Infection and Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands.; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon., Leopold SJ; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Infection and Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands., Hänscheid T; Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal., Adegnika AA; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon.; Institute for Tropical Medicine, German Center for Infection Research (DZIF), University of Tübingen, Tübingen, Germany., Huson MA; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Infection and Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands.; Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands., Grobusch MP; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Infection and Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands. m.p.grobusch@amsterdamumc.nl.; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon. m.p.grobusch@amsterdamumc.nl.; Institute for Tropical Medicine, German Center for Infection Research (DZIF), University of Tübingen, Tübingen, Germany. m.p.grobusch@amsterdamumc.nl.; Masanga Medical Research Unit, Masanga, Sierra Leone. m.p.grobusch@amsterdamumc.nl.; Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa. m.p.grobusch@amsterdamumc.nl.
Jazyk: angličtina
Zdroj: Infection [Infection] 2022 Feb; Vol. 50 (1), pp. 65-82. Date of Electronic Publication: 2021 Jun 10.
DOI: 10.1007/s15010-021-01637-2
Abstrakt: 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 SpO 2  ≤ 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.
(© 2021. The Author(s).)
Databáze: MEDLINE
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