Treatment of Ebola-related critical illness

Abstract

Purpose: To explore contemporary clincial case management of patients with Ebola virus disease.

Methods: A narrative review from a clinical perspective of clinical features, diagnostic tests, treatments and outcomes of patients with Ebola virus disease.

Results: Substantial advances have been made in the care of patients with Ebola virus disease (EVD), precipitated by the unprecedented extent of the 2014-2016 outbreak. There has been improved point-of-care diagnostics, improved characterization of the clinical course of EVD, improved patient-optimized standards of care, evaluation of effective anti-Ebola therapies, administration of effective vaccines, and development of innovative Ebola treatment units. A better understanding of the Ebola virus disease clinical syndrome has led to the appreciation of a central role for critical care clinicians-over 50% of patients have life-threatening complications, including hypotension, severe electrolyte imbalance, acute kidney injury, metabolic acidosis and respiratory failure. Accordingly, patients often require critical care interventions such as monitoring of vital signs, intravenous fluid resuscitation, intravenous vasoactive medications, frequent diagnostic laboratory testing, renal replacement therapy, oxygen and occasionally mechanical ventilation.

Conclusion: With advanced training and adherence to infection prevention and control practices, clinical interventions, including critical care, are feasible and safe to perform in critically ill patients. With specific anti-Ebola medications, most patients can survive Ebola virus infection.

Keywords: Critical care; Ebola; Intensive care.

Fig. 1

A meta-analysis of proportion of 6168 EVD patients presenting with symptoms compared to reference data. Blue indicates a meta-analysis approximate with low or moderate heterogeneity, red is for a high heterogeneity of pooled estimates, and grey is the WHO reference data. Adapted from Rojek AM et al. [30]

Fig. 2

A medical advisor for the Alliance for International Medical Action demonstrating a Biosecure Emergency Care Unit for outbreaks of infectious diseases. Photo credit: Etinosa Yvonne/ALIMA [44]