Beruflich Dokumente
Kultur Dokumente
DOI 10.1007/s00134-014-3568-1
Anders Perner
Robert A. Fowler
Rinaldo Bellomo
Ian Roberts
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Treatment intensity
Haemodialysis
Invasive monitoring
Invasive venlaon
Vasopressor infusion
Oxygen and blood transfusion
Ca2+- and Mg-tesng and dosing
Test-guided uid and electrolyte dosing
Na, K, bicarbonate and Hb POC tesng
Fluid volume guided by assessment
Simple circulatory assessment
Fixed electrolyte dosing*
Fixed uid volume*
Available resources
Fig. 1 A tiered approach to critical care interventions for patients
with Ebola virus disease based on available resources. Hb
Haemoglobin, POC point-of-care. Asterisk indicates that an adult
patient on days with gastrointestinal losses should receive per day
at least 5 l of balanced crystalloid solution and 100 mmol of
potassium
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Electrolyte substitution
The resuscitation fluids used in usual care are crystalloids,
including saline and balanced salt solutions. Although the
choice of fluid can have important impact on acidbase
status and electrolyte levels, the effects and side-effects of
the different crystalloid solutions remain unclear in general, and there is as yet no information on these effects/
side-effects in patients with EVD. The roles of potassium,
bicarbonate, magnesium and calcium supplementation
represent important uncertainties. A pre-mixed solution
that is most appropriate for EVD-related fluid losses is
urgently needed as it may have benefits for patients and
staff. Resolving these uncertainties is essential for the
management of large numbers of patients with EVD.
Other supportive interventions
After the establishment of protocols for parenteral
access and fluid and electrolyte management, other
Perspective
We urgently need to deploy and evaluate Ebola-specific
supportive care. The provision of effective supportive
care for EVD is not only an unmet standard of care for
individual patients, but improving clinical care also plays
a role in controlling the epidemic. If mortality in treatment centres can be lowered through widespread
application of the standard of care, there may be a greater
acceptance of presenting to treatment centres as a means
of surviving Ebola [4]. This may subsequently decrease
the risk of patients remaining in the community and
infecting others.
Conflicts of interest The ICU at Rigshospitalet, where AP is head
of research, receives research funds from Fresenius Kabi and CSL
Behring. The other authors have no conflicts of interests.
References
1. WHO Ebola Response Team (2014)
Ebola virus disease in West Africathe
first 9 months of the epidemic and
forward projections. N Engl J Med
371:14811495
2. Tattevin P, Durante E, Massaquoi M
(2014) Does this patient have Ebola
virus disease? Intensive Care Med
40:17381741
3. Bah EI, Lamah MC, Fletcher T, Jacob
ST, Brett-Major DM, Sall AA, Shindo
N, Fischer WA, Lamontagne F, Saliou
SM, Bausch DG, Moumi B, Jagatic T,
Sprecher A, Lawler JV, Mayet T,
Jacquerioz FA, Baggi MaFM, Vallenas
C, Clement C, Mardel S, Faye O, Faye
O, Soropogui B, Magassouba N,
Koivogui L, Pinto R, Fowler RA (2014)
Clinical presentation of patients with
Ebola virus disease in Conakry, Guinea.
N Engl J Med. doi:
10.1056/NEJMoa1411249
4. Chertow DS, Kleine C, Edwards JK,
Scaini R, Giuliani R, Sprecher A (2014)
Ebola virus disease in West Africa
clinical manifestations and
management. N Engl J Med. doi:
10.1056/NEJMp1413084
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