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Point-of-care ultrasound to assess volume status and pulmonary oedema in malaria patients. / Pugliese, Christina M.; Adegbite, Bayode R.; Edoa, Jean R. et al.

In: Infection, Vol. 50, No. 1, 02.2022, p. 65-82.

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Pugliese CM, Adegbite BR, Edoa JR, Mombo-Ngoma G, Obone-Atome FA, Heuvelings CC et al. Point-of-care ultrasound to assess volume status and pulmonary oedema in malaria patients. Infection. 2022 Feb;50(1):65-82. Epub 2021. doi: 10.1007/s15010-021-01637-2

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Pugliese, Christina M. ; Adegbite, Bayode R. ; Edoa, Jean R. et al. / Point-of-care ultrasound to assess volume status and pulmonary oedema in malaria patients. In: Infection. 2022 ; Vol. 50, No. 1. pp. 65-82.

BibTeX

@article{ff12b8b5edca4d6994bbf75376a5fff5,
title = "Point-of-care ultrasound to assess volume status and pulmonary oedema in malaria patients",
abstract = "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. ",
keywords = "Humans, Malaria/complications, Point-of-Care Systems, Prospective Studies, Pulmonary Edema/diagnostic imaging, Ultrasonography, Vena Cava, Inferior/diagnostic imaging",
author = "Pugliese, {Christina M.} and Adegbite, {Bayode R.} and Edoa, {Jean R.} and Ghyslain Mombo-Ngoma and Obone-Atome, {Fridia A.} and Heuvelings, {Charlotte C.} and Sabine B{\'e}lard and Kalkman, {Laura C.} and Leopold, {Stije J.} and Thomas H{\"a}nscheid and Adegnika, {Ayola A.} and Huson, {Mischa A.} and Grobusch, {Martin P.}",
note = "Funding 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. Funding Information: 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 Lambar{\'e}n{\'e}, a town of approximately 39,000 inhabitants in Moyen-Ogoou{\'e} 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 Lambar{\'e}n{\'e} 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. Publisher Copyright: {\textcopyright} 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",
year = "2022",
month = feb,
doi = "10.1007/s15010-021-01637-2",
language = "English",
volume = "50",
pages = "65--82",
journal = "Infection",
issn = "0300-8126",
publisher = "Urban und Vogel",
number = "1",

}

RIS

TY - JOUR

T1 - Point-of-care ultrasound to assess volume status and pulmonary oedema in malaria patients

AU - Pugliese, Christina M.

AU - Adegbite, Bayode R.

AU - Edoa, Jean R.

AU - Mombo-Ngoma, Ghyslain

AU - Obone-Atome, Fridia A.

AU - Heuvelings, Charlotte C.

AU - Bélard, Sabine

AU - Kalkman, Laura C.

AU - Leopold, Stije J.

AU - Hänscheid, Thomas

AU - Adegnika, Ayola A.

AU - Huson, Mischa A.

AU - Grobusch, Martin P.

N1 - Funding 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. Funding Information: 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. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2022/2

Y1 - 2022/2

N2 - 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.

AB - 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.

KW - Humans

KW - Malaria/complications

KW - Point-of-Care Systems

KW - Prospective Studies

KW - Pulmonary Edema/diagnostic imaging

KW - Ultrasonography

KW - Vena Cava, Inferior/diagnostic imaging

UR - http://www.scopus.com/inward/record.url?scp=85107505123&partnerID=8YFLogxK

U2 - 10.1007/s15010-021-01637-2

DO - 10.1007/s15010-021-01637-2

M3 - Article

C2 - 34110570

VL - 50

SP - 65

EP - 82

JO - Infection

JF - Infection

SN - 0300-8126

IS - 1

ER -

ID: 18673890