Hemodynamic aspects and oxygenation variables in severe malaria of adults in Africa

Objectives: Study of the hemodynamic profile and oxygenation variables in s evere malaria to determine whether they are identical to those observed in severe bacterial infections. Design and setting: Prospective study in an intensive care unit of a West A frican hospital. Patients and participants: Two groups of adult patients hospitalized for se vere malaria according to WHO criteria, a control group (n = 13) with syste mic vascular resistance of 800 dyne s(-1) cm(-5) or higher and a hyperkinet ic group (n = 16) with a level lower than 800 dyne s(-1) cm(-5). Twenty-nin e patients participated in this study (19 semi-immune, 10 nonimmune), Interventions: Before hemodynamic study a loading dose of quinine formiate was administered: 20 mg/kg intravenously for 4 h. Artificial ventilation wa s used in the case of persistent hypoxemia. Measurements and results: The hemodynamic study with Swan-Ganz catheter was performed after filling with 1000 ml lactated Ringer's solution. From a cl inical and a biological standpoint there was no difference between the two groups except for creatine phosphokinase, which was significantly higher in the hyperkinetic group: 2404 +/- 3654 vs. 1898 +/- 1828 IU/l. Hemodynamic and oxygenation variables showed a significant difference in cardiac index (6.1 +/- 1.2 vs. 3.9 +/- 1.2 l min(-1) m(-2)), systemic vascular resistance (536 +/- 143 vs. 1098 +/- 170 dyne s(-1) cm(-5)), oxygen delivery (645 +/- 163 vs. 482 +/- 186 ml min(-1) m(-2)), and oxygen extraction (23 +/- 9% vs . 34 +/- 14%). Oxygen extraction was negatively correlated with oxygen deli very in the control group but not in the hyperkinetic group. Eight of 10 no nimmune patients (80 %) were in the hyperkinetic group versus 8 of 19 semi- immune patients (42 %; p < 0.05). Nine patients in the hyperkinetic group ( 69 %) and seven of the control group (46%) died (NS). Conclusions: In contrast to severe bacterial infections, severe malaria doe s not always induce hyperkinetic-type hemodynamic changes. Such changes are observed mostly in nonimmune subjects.