Pulmonary oedema is a common complication of severe malaria

The dividing line between overhydration and dehydration is narrow. Adults easily develop non-cardiogenic pulmonary oedema if there is limited fluid overload, but on the other hand dehydration and hypovolaemia may lead to hypotension, shock and renal failure. As a guideline the central venous pressure should be kept around 5 cm H₂O. If intensive invasive monitoring is available (e.g. Swan-Ganz catheter in an intensive care unit) an attempt should be made to keep the pulmonary capillary wedge pressure around 15 mm Hg. [The PCWP reflects the pressure in the left atrium]. Pneumonia is observed quite often if coma lasts for longer than 3 days. ARDS (acute respiratory distress syndrome) may occur. This is caused by diffuse damage to the vascular endothelium and the alveolar epithelium. There is a rapid progression towards dyspnoea, arterial hypoxia, bilateral patchy pulmonary infiltrates due to pulmonary oedema with a protein-rich fluid. The treatment is both aetiological and symptomatic: artificial ventilation, with or without intubation or an endotracheal cannula, possibly with NO, high-dosed oxygen and positive end-expiratory pressure (PEEP). Surfactant administered via aerosol might be helpful in this situation, although it is often not available. Further data is needed.

Category: Medicine Notes