Name: Josh Hanson
PhD supervisor: Prof Nick Anstey
Thesis title: “Evaluation of Volume Status, Haemodynamics and Microcirculatory Flow in Adult Patients with Severe Falciparum Malaria.”
Why did you choose this specific area of research?
Malaria kills hundreds of thousands of people every year, yet there is very little information on how best to look after these patients, particularly in the resource-poor setting where they will usually be cared for.
What where the details of your research methodology?
The prospective component of the research (a third of the PhD) involved the care of 28 adult patients in intensive care units in Chittagong, Bangladesh and Rourkela, Orissa, India.
They were enrolled in an observational study examining the response of patients to fluid resuscitation, one of the most fundamental aspects of patient care.
During the study patients had their cardiac function and circulation followed with advanced monitoring equipment while blood flow at a tissue level was simultaneously analysed with a micro vascular camera.
What are the main health implications of your research?
After several days of fever, sweating, vomiting and, frequently, impaired consciousness, adults with severe malaria are usually dehydrated - some profoundly so. This will tend to worsen the disturbed metabolic and kidney function seen in these patients.
Fluid replacement will be required, yet at the same time, patients with malaria have a tendency for their blood vessels to leak fluid and if fluid is given too quickly, this can leave the circulation and end up in the tissues. If this occurs in the lungs – pulmonary oedema – it can be fatal. Getting the right balance between over-hydration and under-hydration is challenging.
What are the major findings of your research?
Liberal fluid administration does little to improve blood flow in the tissues with little benefit seen on kidney function and metabolic disturbance.
Meanwhile, over half of the patients treated in this way developed evidence of fluid in the lungs, a condition that may have been fatal if they were not being cared for in a controlled study environment. Central venous pressure a measure that had been suggested as a guide to fluid resuscitation was not helpful in determining which patients responded well to fluid loading.
Our research has led to modification of the World Health Organisation guidelines for clinicians managing adults with severe malaria.
What are the next steps for your research?
We are looking to establish a study site in Myanmar where there is a higher prevalence of severe malaria, so we can see how patients respond to fluid therapy without the support of advanced monitoring equipment. This represents the real-world situation as almost all adults with severe malaria will be managed in a resource-poor setting.