Evidence-based guidelines for supportive care of patients with Ebola virus disease

François Lamontagne¹, Robert A Fowler², Neill K Adhikari², Srinivas Murthy³, David M Brett-Major⁴, Michael Jacobs⁵, Timothy M Uyeki⁶, Constanza Vallenas⁷, Susan L Norris⁷, William A Fischer 2nd⁸, Thomas E Fletcher⁹, Adam C Levine¹⁰, Paul Reed¹¹, Daniel G Bausch¹², Sandy Gove¹³, Andrew Hall¹⁴, Susan Shepherd¹⁵, Reed A Siemieniuk¹⁶, Marie-Claude Lamah¹⁷, Rashida Kamara¹⁸, Phiona Nakyeyune¹⁹, Moses J Soka²⁰, Ama Edwin²¹, Afeez A Hazzan²², Shevin T Jacob²³, Mubarak Mustafa Elkarsany²⁴, Takuya Adachi²⁵, Lynda Benhadj²⁶, Christophe Clément²⁷, Ian Crozier²⁸, Armando Garcia²⁹, Steven J Hoffman³⁰, Gordon H Guyatt³¹

Affiliations

¹ Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada; Centre de recherche du CHUS de Sherbrooke, Sherbrooke, QC, Canada. Electronic address: francois.lamontagne@usherbrooke.ca.
² Department of Medicine, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
³ Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada.
⁴ US Military HIV Research Program, Henry M. Jackson Foundation, Bethesda, MD, USA.
⁵ Royal Free London NHS Foundation Trust, London, UK.
⁶ US Centers for Disease Control and Prevention, Atlanta, GA, USA.
⁷ World Health Organization, Geneva, Switzerland.
⁸ Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁹ Liverpool School of Tropical Medicine, Liverpool, UK.
¹⁰ Ebola Research Team, International Medical Corps, Washington, DC, USA; Department of Emergency Medicine, Warren Alpert Medical School, Providence, RI, USA.
¹¹ Center for Global Health Engagement-Uniformed Services University of the Health Sciences, Bethesda, MD, USA; US Public Health Service, Rockville, MD, USA.
¹² World Health Organization, Geneva, Switzerland; Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA.
¹³ Integrated Management of Adolescent and Adult Illness-Integrated Management of Childhood Illness) Alliance, San Francisco, CA, USA.
¹⁴ London, UK.
¹⁵ Alliance for International Medical Action, Dakar, Senegal.
¹⁶ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
¹⁷ Doctors Without Borders, Conakry, Guinea.
¹⁸ Ministry of Health and Sanitation, Freetown, Sierra Leone.
¹⁹ London School of Hygiene & Tropical Medicine, London, UK.
²⁰ Ministry of Health, Monrovia, Liberia.
²¹ Palliative Care Service, Korle Bu Teaching Hospital, Accra, Ghana; Ghana Health Service Ethical Review Committee, Accra, Ghana.
²² Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Healthcare Studies, The College at Brockport, State University of New York, NY, USA.
²³ Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA.
²⁴ Karary University, Khartoum, Sudan.
²⁵ Department of Infectious Diseases, Toshima Hospital, Tokyo, Japan.
²⁶ Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Canada; Centre de recherche, Hôpital Charles-Le Moyne, Longueuil, QC, Canada.
²⁷ Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France.
²⁸ Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
²⁹ Doctors Without Borders, Geneva, Switzerland.
³⁰ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health, and Osgoode Hall Law School, York University, Toronto, ON, Canada.
³¹ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.

PMID: 29054555
PMCID: PMC6636325
DOI: 10.1016/S0140-6736(17)31795-6

Evidence-based guidelines for supportive care of patients with Ebola virus disease

François Lamontagne et al. Lancet. 2018.

. 2018 Feb 17;391(10121):700-708.

doi: 10.1016/S0140-6736(17)31795-6. Epub 2017 Oct 17.

Authors

Affiliations

¹ Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada; Centre de recherche du CHUS de Sherbrooke, Sherbrooke, QC, Canada. Electronic address: francois.lamontagne@usherbrooke.ca.
² Department of Medicine, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
³ Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada.
⁴ US Military HIV Research Program, Henry M. Jackson Foundation, Bethesda, MD, USA.
⁵ Royal Free London NHS Foundation Trust, London, UK.
⁶ US Centers for Disease Control and Prevention, Atlanta, GA, USA.
⁷ World Health Organization, Geneva, Switzerland.
⁸ Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁹ Liverpool School of Tropical Medicine, Liverpool, UK.
¹⁰ Ebola Research Team, International Medical Corps, Washington, DC, USA; Department of Emergency Medicine, Warren Alpert Medical School, Providence, RI, USA.
¹¹ Center for Global Health Engagement-Uniformed Services University of the Health Sciences, Bethesda, MD, USA; US Public Health Service, Rockville, MD, USA.
¹² World Health Organization, Geneva, Switzerland; Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA.
¹³ Integrated Management of Adolescent and Adult Illness-Integrated Management of Childhood Illness) Alliance, San Francisco, CA, USA.
¹⁴ London, UK.
¹⁵ Alliance for International Medical Action, Dakar, Senegal.
¹⁶ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
¹⁷ Doctors Without Borders, Conakry, Guinea.
¹⁸ Ministry of Health and Sanitation, Freetown, Sierra Leone.
¹⁹ London School of Hygiene & Tropical Medicine, London, UK.
²⁰ Ministry of Health, Monrovia, Liberia.
²¹ Palliative Care Service, Korle Bu Teaching Hospital, Accra, Ghana; Ghana Health Service Ethical Review Committee, Accra, Ghana.
²² Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Healthcare Studies, The College at Brockport, State University of New York, NY, USA.
²³ Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA.
²⁴ Karary University, Khartoum, Sudan.
²⁵ Department of Infectious Diseases, Toshima Hospital, Tokyo, Japan.
²⁶ Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Canada; Centre de recherche, Hôpital Charles-Le Moyne, Longueuil, QC, Canada.
²⁷ Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France.
²⁸ Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
²⁹ Doctors Without Borders, Geneva, Switzerland.
³⁰ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health, and Osgoode Hall Law School, York University, Toronto, ON, Canada.
³¹ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.

PMID: 29054555
PMCID: PMC6636325
DOI: 10.1016/S0140-6736(17)31795-6

Abstract

The 2013-16 Ebola virus disease outbreak in west Africa was associated with unprecedented challenges in the provision of care to patients with Ebola virus disease, including absence of pre-existing isolation and treatment facilities, patients' reluctance to present for medical care, and limitations in the provision of supportive medical care. Case fatality rates in west Africa were initially greater than 70%, but decreased with improvements in supportive care. To inform optimal care in a future outbreak of Ebola virus disease, we employed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to develop evidence-based guidelines for the delivery of supportive care to patients admitted to Ebola treatment units. Key recommendations include administration of oral and, as necessary, intravenous hydration; systematic monitoring of vital signs and volume status; availability of key biochemical testing; adequate staffing ratios; and availability of analgesics, including opioids, for pain relief.

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Conflict of interest statement

Declaration of interests

STJ is a senior medical adviser for Shift Labs. SLN, RAS, and GHG are members of the GRADE Working Group. SLN has published numerous papers related to GRADE, and her career benefited from this relationship. TEF and SJH have been consultants to WHO. All other authors declare no competing interests.

Comment in

Ebola virus disease and palliative care in humanitarian crises.
Escobio F, Nouvet E. Escobio F, et al. Lancet. 2019 Mar 16;393(10176):1100. doi: 10.1016/S0140-6736(19)30295-8. Epub 2019 Mar 14. Lancet. 2019. PMID: 30894269 No abstract available.

References

1. Fowler RA, Fletcher T, Fischer WA 2nd, et al. Caring for critically ill patients with ebola virus disease. Perspectives from west Africa. Am J Respir Crit Care Med 2014; 190: 733–37. - PubMed
1. Lamontagne F, Clement C, Fletcher T, Jacob ST, Fischer WA 2nd, Fowler RA. Doing today’s work superbly well--treating Ebola with current tools. N Engl J Med 2014; 371: 1565–66. - PubMed
1. Brett-Major DM, Jacob ST, Jacquerioz FA, et al. Being ready to treat Ebola virus disease patients. Am J Trop Med Hyg 2015; 92: 233–37. - PMC - PubMed
1. Leligdowicz A, Fischer WA 2nd, Uyeki TM, et al. Ebola virus disease and critical illness. Crit Care 2016; 20: 217. - PMC - PubMed
1. Murthy S, Ebola Clinical Care authors group. Ebola and provision of critical care. Lancet 2015; 385: 1392–93. - PubMed

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Evidence-based guidelines for supportive care of patients with Ebola virus disease

Affiliations

Evidence-based guidelines for supportive care of patients with Ebola virus disease

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical