Introduction
Recommendations for the management of severe malaria and severe dengue in resource-limited settings
Severe falciparum malaria
Severe dengue
Conclusions
Fluid management of severe malaria | We recommend not to use fluid bolus therapy in normotensive patients with severe falciparum malaria (1A). We suggest that patients receive maintenance isotonic crystalloid fluid therapy (2–4 ml/kg/h), which may subsequently be reduced to 1 ml/kg/h in patients receiving additional fluids, e.g. through enteral tube feeding (2D). We suggest that, in patients with hypotensive shock, fluid bolus therapy (30 ml/kg) with isotonic crystalloids be commenced (ungraded) and, if available, early initiation of vasopressor medication (ungraded) |
Timing of enteral feeding in cerebral malaria | We suggest initiating enteral feeing in non-intubated adult patients with cerebral malaria after 60 h, in order to limit the possibility of aspiration pneumonia (2B). There are insufficient data to make this recommendation for children with cerebral malaria |
Permissive hypercapnia in ventilated cerebral malaria | We suggest not to use a strategy of permissive hypercapnia to achieve ventilation with low tidal volumes in patients with cerebral malaria, because of the high incidence of brain swelling in these patients (ungraded) |
Fluid management in severe dengue | We recommend that fluid resuscitation in severe dengue is executed promptly and guided by pulse pressure, capillary refill time, haematocrit and urine output according to WHO guidelines, and that fluid therapy should be restricted as soon as the critical phase of the disease is over to avoid pulmonary oedema (1C). We recommend that rapid administration of large fluid boluses should be avoided, unless the patient is hypotensive (1D). We recommend that, in dengue patients with compensated shock, colloid fluids are not used (1A) |
Use of corticosteroids in severe dengue | We recommend not to use corticosteroids in the treatment of severe dengue (1B) |
Use of prophylactic platelet transfusion in severe dengue | We recommend not to use prophylactic platelet transfusion for thrombocytopenia in the absence of active bleeding complications, or other risk factors (uncontrolled arterial hypertension, recent stroke, head trauma or surgery, continuation of an anticoagulant treatment, or existing haemorrhagic diathesis) (1B) |