Guidelines for the Early Clinical and Public Health Management of ...

Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease)
5. INITIATE FLUID RESUSCITATION Minimum of 20 mls/kg isotonic crystalloid
(e.g. Hartmann’s or 0.9% w/v NaCl) or
colloid stat.
Crystalloid fluid administration should be
at 100% of maintenance requirements until
cardiovascular stability is restored.
Start immediately with Hartmann’s,
normal saline, or colloid. Hartmann’s is
physiologically the best solution but colloid
fluid therapy (5% w/v albumin) may be used
in the early resuscitation period.
Critical to evaluate after initial
resuscitation and determine if goals met.
If not succeeding consider early intubation
and commencing inotropes
Continuous re-evaluation of response to
interventions, with repeated intervention
as necessary essential until goals achieved
CVP 8 – 12 mmHg
Age appropriate MAP:
• Infant/young child ~ 45mmHg
• Older child ~ 55mmHg
• Adolescent/adult ≥ 65mmHg
Urine output > 1ml/kg/hr
Central venous oxygen (ScvO2) of
≥ 70% or
Mixed venous O 2
saturation
(Sv O2) of ≥ 65%
Lactate < 2 mmols/L or falling
Maintain Hb 7 - 9 g/dl
(desired level dependent on comorbidities)
6. GIVE IV/IO ANTIBIOTICS WITHOUT
DELAY
Ceftriaxone special precautions: see No.3 above
For infants < 8 weeks (2 months) the addition of amoxicillin is to provide cover for
listeria and enterococci and of gentamicin to enhance GNB cover and synergistic
increase in activity vs. group B streptococci.
7. REASSESS CLINICALLY Reassess fluid requirements frequently
If meningitis/ ICP, re-assess fluid needs
If continued evidence of haemodynamic
instability, repeat fluid bolus in accordance
with response to resuscitation
Monitor blood glucose and assess need for
dextrose
Hypoglycaemia should be treated with 5ml/
kg of 10% dextrose solution and subsequent
inclusion of dextrose in maintenance fluids
Assess K+ needs as soon as U&E results
available
Maintain glucose ≥ lower limit of
normal, but < 10 mmol/L.
Maintain K+ within normal range
8. LUMBAR PUNCTURE SHOULD NOT BE CARRIED OUT AT THIS TIME The only definitive way to
ascertain the presence or absence
of meningitis is to examine CSF.
As this will impact on necessary
patient follow-up, LP should be
considered when the patient
stabilises and provided there are
no contra-indications to LP. This
may be on Day 2 or 3.
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