From U Washington: Clinical Presentation and Management of Severe Ebola Virus Disease

Ann Am Thorac Soc. 2014 Nov 4. [Epub ahead of print]

Clinical Presentation and Management of Severe Ebola Virus Disease.

West TE1, von Saint André-von Arnim A.

Author information

• 1University of Washington, Div of Pulmonary & Critical Care Medicine , Harborview Medical Center , Box 359640 , 325 9th Ave , Seattle, Washington, United States, 98104 , 206-897-5271 , 206-897-5392 ; tewest@uw.edu.

Abstract

Clinicians caring for patients with Ebola virus disease must be familiar not only with screening and infection control measures, but also with management of severe infection. By integrating experience from several Ebola epidemics with best practices for managing critical illness, this report focuses on the clinical presentation and management of severely ill infants, adults, and children with Ebola virus disease. Fever, fatigue, vomiting, diarrhea and anorexia are the most common symptoms of the 2014 outbreak. Profound fluid losses from the gastrointestinal tract result in volume depletion, metabolic abnormalities (including hyponatremia, hypokalemia, and hypocalcemia), shock, and organ failure. Widespread hemorrhage occurs in fewer than 20 percent of patients. Individuals with respiratory, neurological, or hemorrhagic symptoms have a higher risk of death. Optimal treatment requires conscientious correction of fluid and electrolyte losses. Additional management considerations include search for co-infection or superinfection, treatment of shock (with intravenous fluids and vasoactive agents), acute kidney injury (with renal replacement therapy), and respiratory failure (with invasive mechanical ventilation), provision of nutrition support, pain control, psychosocial support, and use of strategies to reduce complications of critical illness. Cardiopulmonary resuscitation may be appropriate in certain circumstances. Extracorporeal life support is not indicated. There is no proven anti-viral agent to treat Ebola virus disease, although several experimental treatments may be considered. Even in the absence of anti-viral therapies, intensive supportive care has the potential to markedly blunt the high case fatality rate reported to date. Meticulous attention to use of personal protective equipment and strict adherence to infection control protocols should permit the safe provision of intensive treatment to severely ill patients with Ebola virus disease.