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

François Lamontagne; Robert A Fowler; Neill K Adhikari; Srinivas Murthy; David M Brett-Major; Michael Jacobs; Timothy M Uyeki; Constanza Vallenas; Susan L Norris; William A Fischer 2nd; Thomas E Fletcher; Adam C Levine; Paul Reed; Daniel G Bausch; Sandy Gove; Andrew Hall; Susan Shepherd; Reed A Siemieniuk; Marie-Claude Lamah; Rashida Kamara; Phiona Nakyeyune; Moses J Soka; Ama Edwin; Afeez A Hazzan; Shevin T Jacob; Mubarak Mustafa Elkarsany; Takuya Adachi; Lynda Benhadj; Christophe Clément; Ian Crozier; Armando Garcia; Steven J Hoffman; Gordon H Guyatt

doi:10.1016/S0140-6736(17)31795-6

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

Lancet. 2018 Feb 17;391(10121):700-708. doi: 10.1016/S0140-6736(17)31795-6. Epub 2017 Oct 17.

Authors

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.

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Africa, Western / epidemiology
Disease Management
Disease Outbreaks*
Evidence-Based Medicine / methods*
Health Facilities
Hemorrhagic Fever, Ebola / epidemiology*
Hemorrhagic Fever, Ebola / psychology
Hospitalization
Humans
Monitoring, Physiologic
Pain Management
Patient Acceptance of Health Care / psychology*
Practice Guidelines as Topic

Abstract

Publication types

MeSH terms

Grants and funding