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

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

Author information

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.

PMID:
29054555
DOI:
10.1016/S0140-6736(17)31795-6
[Indexed for MEDLINE]

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