Point-of-care ultrasound to assess volume status and pulmonary oedema in malaria patients

Abstract

Fluid management is challenging in malaria patients given the risks associated with intravascular fluid depletion and iatrogenic fluid overload leading to pulmonary oedema. Given the limitations of the physical examination in guiding fluid therapy, we evaluated point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) and lungs as a novel tool to assess volume status and detect early oedema in malaria patients. To assess the correlation between IVC and lung ultrasound (LUS) indices and clinical signs of hypovolaemia and pulmonary oedema, respectively, concurrent clinical and sonographic examinations were performed in an observational study of 48 malaria patients and 62 healthy participants across age groups in Gabon. IVC collapsibility index (CI)\u2009≥\u200950% on enrolment reflecting intravascular fluid depletion was associated with an increased number of clinical signs of hypovolaemia in severe and uncomplicated malaria. With exception of dry mucous membranes, IVC-CI correlated with most clinical signs of hypovolaemia, most notably sunken eyes (r\u2009=\u20090.35, p\u2009=\u20090.0001) and prolonged capillary refill (r\u2009=\u20090.35, p\u2009=\u20090.001). IVC-to-aorta ratio\u2009≤\u20090.8 was not associated with any clinical signs of hypovolaemia on enrolment. Among malaria patients, a B-pattern on enrolment reflecting interstitial fluid was associated with dyspnoea (p\u2009=\u20090.0003), crepitations and SpO2\u2009≤\u200994% (both p\u2009<\u20090.0001), but not tachypnoea (p\u2009=\u20090.069). Severe malaria patients had increased IVC-CI (p\u2009<\u20090.0001) and more B-patterns (p\u2009=\u20090.004) on enrolment relative to uncomplicated malaria and controls. In malaria patients, POCUS of the IVC and lungs may improve the assessment of volume status and detect early oedema, which could help to manage fluids in these patients.