The largest-ever Ebola virus disease outbreak is ravaging West Africa, but with more personnel, basic monitoring, and supportive treatment, many of the sickest patients with Ebola virus disease do not need to die, note the authors of a new paper published ahead of print publication in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.
"Caring for Critically Ill Patients with Ebola Virus Disease: Perspectives from West Africa," written by Robert Fowler, MD, MDCM, MSc, associate professor of medicine at University of Toronto, and colleagues who have fought the Ebola crisis abroad, covers such topics as:
•Origins of the 2014 West Africa Ebola Virus Disease Outbreak
•Public Health Challenges in Responding to Ebola Virus Disease
•Clinical and Pathophysiological Features of Ebola Virus Disease
•Supportive and Specific Treatments of Ebola Virus Disease
•The Importance and Challenges of Personal Protective Equipment
•Socio-cultural Context of Clinical Care
•The Imperative to Improve Clinical Outcomes of Ebola Virus Disease
The authors enumerate a number of ways in which critical care medicine can improve the outcomes of Ebola virus infection. These include:
•Demystifying Ebola virus disease by reconsidering it as one of the many examples of transmissible infection-related critical illness that benefit from goal-directed supportive and specific intensive care.
•Recognizing that the predominant Ebola virus disease clinical syndrome is gastrointestinal - nausea, vomiting and diarrhea - that can lead to profound intravascular volume depletion and metabolic abnormalities and require prevention and treatment.
•Appreciating the important role for basic biochemistry and laboratory markers to diagnose metabolic abnormalities and guide the response to therapy.
•Advocating that these therapies truly can and should be available to all patients in resource-constrained and resource-rich environments.
•Understanding that the fundamental skills of critical care clinicians represent the fundamental needs of patients with Ebola virus disease.
•Anticipating that with better supportive care, the outcomes of infection will dramatically improve.
"While the primary goal of any outbreak is to stop it as quickly as possible, discharging increasing numbers of cured patients to their community provides affirmation that supportive and specific acute care should play an increasing role in delivering care to critically ill patients, irrespective of the presence of an intensive care unit," the authors write. "Ebola virus disease represents an illness ready for a paradigm shift in care delivery and outcomes, and the profession of critical care medicine can and should be instrumental in making this happen."
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