Optimizing the intensive care treatment of severe and complicated plasmodium falciparum malaria in nonimmune patients

This study analyses the intensive care treatment of 48 patients admitted to the Intensive Care Unit (ICU) at the Infectious Diseases Clinical Hospital No. 2, Moscow, Russia, between 2007 and 2019, with a severe and complicated form of P. falciparum malaria (B50.8 ICD 10). Objective. The aim of this study was to improve the intensive care treatment for severe and complicated P. falciparum malaria. The treatment strategy implemented was aimed at preventing ischaemia-reperfusion injury to organs, as well as haemorrhagic complications. The ICU Case Management Protocol set up indications for transferring patients to the ICU which provide preventive (prior to the development of renal failure) application of extracorporeal hemocorrection methods (continuous venous-venous hemodiafiltration and plasmapheresis in a plasma exchange mode) and mechanical ventilation under a medically induced coma, given impaired consciousness as the initial symptom of patients. Results. Successful treatment outcome in a majority of the patients (93.8%), shorter ICU length of stay (6.67 ± 1.9 days as compared to 94 ± 1.6 before introduction of the protocol), a median parasite clearance time of 37.50 hours (95% CI 36.21-38.18), and a reduced mortality rate from 29.1% to 6.25% support the efficacy of the ICU protocol in managing severe and complicated P. falciparum malaria. © 2020 V. B. Chentsov et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • 1 Infectious Diseases Clinical Hospital No. 2, Moscow, Russian Federation
  • 2 Peoples' Friendship University of Russia, (RUDN University), Moscow, Russian Federation
  • 3 Martsinovsky Institute of Medical Parasitology, Tropical & Vector-Borne Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
antioxidant; artemether plus benflumetol; artesunate; doxycycline; fresh frozen plasma; furosemide; mannitol; mefloquine; meropenem; midazolam; propofol; quinine; acute kidney failure; adolescent; adult; aged; anuria; Article; artificial ventilation; bleeding; brain edema; case report; clinical article; clinical outcome; coma; consciousness disorder; continuous hemodiafiltration; controlled study; disease severity; drug substitution; drug withdrawal; female; human; intensive care; intensive care unit; kidney failure; length of stay; malaria falciparum; male; mortality rate; nonhuman; parasite clearance; parasite load; parasitemia; plasma exchange; plasmapheresis; reperfusion injury; symptomatology; ventilator associated pneumonia
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