IX · Overnight · respiratory failure Severe Falciparum Malaria10 / 18
P/F ratio · first 24 hBerlin threshold for severe ARDS = 100
Malaria-ARDS — whySequestration — parasitised RBCs adhere to pulmonary endothelium → microvascular obstruction
Cytokine storm — TNF-α, IL-1, IL-6 → alveolar capillary leak
Paradox after treatment — ARDS often worsens 24–48 h post-artesunate (parasite lysis)
Conservative fluids — aggressive resus worsens oedema (FEAST)
Prone if P/F <150 for ≥12 h — standard ARDS bundle
ECMO — last resort for refractory ARDS
★ Distinction pointARDS often worsens after artesunate initiation. This is expected — parasite lysis releases inflammatory mediators. Continue treatment; escalate respiratory support.
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