VIII · ICU management
Severe Falciparum Malaria09 / 18
Multi-system organ support.
Deaths in severe malaria are caused by multi-organ failure, not parasite burden. ICU support saves the patient — the drug clears the parasite.
Lung-protective
B · Ventilation
  • · TV 6 mL/kg IBW · Plateau ≤30 cmH₂O
  • · PEEP 12 · FiO₂ to SpO₂ ≥95%
  • · Prone if P/F <150 · ECMO last resort
Vasopressor
C · Circulation
  • · Noradrenaline first-line · MAP ≥65
  • · Arterial line essential
  • · Conservative fluids — FEAST: boluses kill
Antimalarial
D · Artesunate
  • · 2.4 mg/kg · 0 h / 12 h / 24 h / daily
  • · Repeat parasitaemia 12-hourly
  • · Switch to oral ACT when tolerating
Monitoring
E · Glucose
  • · Hourly monitoring — mandatory
  • · Target 5–10 mmol/L
  • · Treat: 50 mL 50% dextrose IV stat
RRT
F · Renal
  • · K⁺ 6.2 → urgent CRRT now
  • · Early CVVHDF for AKI
  • · Avoid nephrotoxins · protect tubules
Seizures
G · Neuro
  • · IV lorazepam first-line
  • · Levetiracetam if recurrent
  • · Steroids CONTRAINDICATED — SNAP
CICM Fellowship Masterclass · 2026Dr Timothy Chimunda FCICM
ICU Multi-Organ Support09 / 18
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