Not yet time to use mortality as an outcome in trials of intravenous fluid therapy in severe malaria

Abstract

There has been debate in this journal regarding the use of aggressive intravenous fluid therapy in severe malaria [ 1 Maitland K. Severe malaria: lessons learned from the management of critical illness in children. Trends Parasitol. 2006; 22: 457-462 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar , 2 Maitland K. Newton C.R. Acidosis of severe falciparum malaria: heading for a shock?. Trends Parasitol. 2005; 21: 11-16 Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar , 3 Planche T. Malaria and fluids – balancing acts. Trends Parasitol. 2005; 21: 562-567 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar ]. As is often the case, there is much agreement but also some important differences of opinion and interpretation. There is agreement that metabolic derangements (particularly lactic acidosis) are among the most important complications of severe malaria and are promising targets for adjunctive therapies. In addition, there is broad agreement that lactic acidosis results from poor tissue perfusion. There are, however, important disagreements about the role of intravascular volume depletion in severe malaria and how future studies should be designed to resolve this question.