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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Cardiac function and hemodynamics in Kenyan children with severe malaria
Critical Care Medicine, Volume 38, No. 3, Year 2010
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Description
Objectives: Mortality from severe malaria reMains unacceptably high in sub-Saharan Africa. Several markers of cardiovascular compromise and metabolic acidosis correlate with mortality. The role of cardiac dysfunction in the pathogenesis of severe childhood malaria reMains unknown. Design: We examined 30 children admitted with severe malaria by using portable echocardiography to assess their cardiac function and hemodynamic status on admission (day 0), day 1, and discharge. We compared hemodynamic parameters in two study groups: children presenting with metabolic acidosis (base deficit >8) and children without acidosis. Setting: High-dependency unit, Kilifi District Hospital, Kenya. Interventions: Acidotic patients received fluid resuscitation with either dextran 70 or starch at admission. Measurements and Main Results: Several markers of hemodynamic compromise were noted on admission, including severe tachycardia, low stroke volume index, and high inferior vena cava collapsibility index, which improved with subsequent readings. Overall, cardiac function assessed by ejection fraction (63.1% ± 5.2% vs. 71.9% ± 2.8%; p <.001) and left myocardial performance index (0.32 ± 0.16 vs. 0.25 ± 0.08; p =.03) was mildly abnormal on admission compared with discharge. Acidotic patients had worse hemodynamic indicators, with a significantly higher inferior vena cava collapsibility index on day 0 than nonacidotic patients (52.1 ± 21.9 vs. 37.7 ± 15.4; p =.03), plus lower stroke volume index and worse cardiac function with higher left myocardial performance index (0.38 ± 0.18 vs. 0.26 ± 0.11; p =.05). Stroke volume index increased after first fluid bolus in 80% of children. Conclusions: Children with severe malaria and metabolic acidosis have evidence of hypovolemia and evidence of cardiac dysfunction. Copyright © 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
Authors & Co-Authors
Yacoub, Sophie
United Kingdom, London
Imperial College London
Lang, Hans Joerg
Kenya, Nairobi
Wellcome Trust Research Laboratories Nairobi
United Kingdom, London
Wellcome Trust
Shebbe, Mohammed
Kenya, Nairobi
Wellcome Trust Research Laboratories Nairobi
Timbwa, Molline
Kenya, Nairobi
Wellcome Trust Research Laboratories Nairobi
Ohuma, Eric O.
Kenya, Nairobi
Wellcome Trust Research Laboratories Nairobi
Tulloh, Robert M.R.
United Kingdom, Bristol
Bristol Royal Hospital for Children
Maitland, Kathryn M.
Kenya, Nairobi
Wellcome Trust Research Laboratories Nairobi
United Kingdom, London
Wellcome Trust
Statistics
Citations: 60
Authors: 7
Affiliations: 4
Identifiers
Doi:
10.1097/CCM.0b013e3181cd114a
ISSN:
00903493
e-ISSN:
15300293
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Noncommunicable Diseases
Study Locations
Kenya