Management of patients with severe melioidosis in intensive care

Melioidosis frequently presents as severe sepsis or septic shock. Appropriate managementtherefore dictates familiarity with standard sepsis therapies and approaches to intensive care. These treatments include early and aggressive haemodynamic management using intravenous fluids, vasopressors, and inotropes in a goal-directed fashion to maximise oxygen delivery to peripheral tissues. In the critically ill patient, oxygen consumption can be reduced with antipyretics, sedation, and mechanical ventilation. The role of glycaemic control and adjunctive treatments such as corticosteroids, activated protein C and granulocyte colony stimulating factor (G-CSF) are controversial. G-CSF has been formally studied in melioidosis patients, but the level of evidence for adjunctive treatments is insufficient. Mechanical ventilation for respiratory failure or acute lung injury may be required, necessitating an understanding of basic ventilator therapies. Treatment of acute renal injury and use of appropriate prophylactic therapies is also essential. Most, if not all,may be key factors in the reduction of the high mortality rate from melioidosis in developingcountries.