Experiences with severe P-falciparum malaria in the intensive care unit

Objective: To review the clinical profiles and therapies instituted for pat ients with severe malaria admitted to an ICU. Design: Retrospective study. Setting: Internal ICU of a tertiary care centre. Patients and participants: Between January, 1992, and February, 1999, 104 p atients with malaria were admitted to the General Hospital of Vienna. Sixty -nine patients suffered from Plasmodium falciparum malaria (66%), seven of these were admitted to the ICU. Measurement and results: Seven patients were admitted to the ICU, of whom t hree died (4% in hospital case-fatality rate). Four patients required mecha nical ventilation because of respiratory insufficiency and adult respirator y distress syndrome (ARDS), of whom three died. Three patients were treated with inhaled nitric oxide (NO) and kinetic therapy; one patient required e xtracorporeal veno-venous oxygenation. All patients who died required haemo filtration because of acute renal failure. Conclusion: As II falciparum is a potentially life-threatening disease, rel iable criteria for ICU admission should be defined and risk factors identif ied. Early ICU monitoring should be attempted, especially under the followi ng conditions: (1) lack of clinical response to anti-malarial treatment wit hin 48 h and/or (2) any signs of neurological disturbance (hypoglycaemia ex cluded). Prospective multicentre trials and guidelines for supportive inten sive care are urgently needed.