Critical Care for Multiple Organ Failure Secondary to Ebola Virus Disease in the United States

Abstract

Objective: This report describes three patients with Ebola virus disease who were treated in the United States and developed for severe critical illness and multiple organ failure secondary to Ebola virus infection. The patients received mechanical ventilation, renal replacement therapy, invasive monitoring, vasopressor support, and investigational therapies for Ebola virus disease.

Data sources: Patient medical records from three tertiary care centers (Emory University Hospital, University of Nebraska Medical Center, and Texas Health Presbyterian Dallas Hospital).

Study selection: Not applicable.

Data extraction: Not applicable.

Data synthesis: Not applicable.

Conclusion: In the severe form, patients with Ebola virus disease may require life-sustaining therapy, including mechanical ventilation and renal replacement therapy. In conjunction with other reported cases, this series suggests that respiratory and renal failure may occur in severe Ebola virus disease, especially in patients burdened with high viral loads. Ebola virus disease complicated by multiple organ failure can be survivable with the application of advanced life support measures. This collective, multicenter experience is presented with the hope that it may inform future treatment of patients with Ebola virus disease requiring critical care treatment.

Figure 1

Chest radiographs of patients with Ebola virus disease obtained during critical illness period. Chest radiographic findings obtained during critical illness course of patient 1 (A–C), patient 2 (D–F), and patient 3 (G–I).

Figure 2

Graphic presentation of plasma viral load (C_t value) in correlation with minute ventilation (MV) and fractionated oxygen requirement. MV was calculated based on documented tidal volume and respiratory rate (L/min). A, Patient 1 data are shown in circles (closed circles = minutes ventilation, open circles = F_IO2, and half-closed circles = viral load [C_t values]). B, Patient 2 data are shown in squares (closed squares = minutes ventilation, open squares = F_IO2, and half-closed squares = viral load [C_t values]). C, Patient 3 data are shown in triangles (closed triangles = minutes ventilation, open triangles = F_IO2, and half-closed triangles = viral load [C_t values]). Grey shading area represents period when patients were on mechanical ventilator. RRT = renal replacement therapy.

Figure 3

Graphic presentation of serum lactic acid in correlation with anion gap (AG). Black lines represent serum lactate, and gray lines represent anion gap. Patient 1 data are shown with closed circles (serum lactate) and open circles (anion gap). Patient 2 data are shown with closed squares (serum lactate) and open squares (anion gap). Patient 3 data are shown with closed triangles (serum lactate) and open triangles (anion gap). RRT = renal replacement therapy.

Figure 4

Graphic presentation of liver enzymes levels throughout the critical care period of patients with Ebola virus disease. Black lines represent serum aspartate aminotransferase (AST), and gray lines represent serum alanine aminotransferase (ALT). Patient 1 data are shown with closed circles (AST) and open circles (ALT). Patient 2 data are shown with closed squares (AST) and open squares (ALT). Patient 3 data are shown with closed triangles (AST) and open triangles (ALT).

Figure 5

Graphic presentation of serum creatinine of patients with Ebola virus disease and in correlation with viral load. Patient 1 (bottom) data are shown in closed circles (serum creatinine) and open circles (viral load [presented as C_t value]). Patient 2 (middle) data are shown in closed squares (serum creatinine) and open squares (viral load [presented as C_t value]). Patient 3 (top) data are shown in closed triangles (serum creatinine) and open triangles (viral load [presented as C_t value]). Arrows represent renal replacement therapy (RRT) initiation.

Figure 6

Graphic presentation of coagulation profile and platelet count of patients with Ebola virus disease and in correlation with viral load. INR = international normalized ratio, RRT = renal replacement therapy.