title: Ebola virus disease and critical illness.
abstract: As of 20 May 2016 there have been 28,646 cases and 11,323 deaths resulting from the West African Ebola virus disease (EVD) outbreak reported to the World Health Organization. There continue to be sporadic flare-ups of EVD cases in West Africa.EVD presentation is nonspecific and characterized initially by onset of fatigue, myalgias, arthralgias, headache, and fever; this is followed several days later by anorexia, nausea, vomiting, diarrhea, and abdominal pain. Anorexia and gastrointestinal losses lead to dehydration, electrolyte abnormalities, and metabolic acidosis, and, in some patients, acute kidney injury. Hypoxia and ventilation failure occurs most often with severe illness and may be exacerbated by substantial fluid requirements for intravascular volume repletion and some degree of systemic capillary leak. Although minor bleeding manifestations are common, hypovolemic and septic shock complicated by multisystem organ dysfunction appear the most frequent causes of death.Males and females have been equally affected, with children (0-14 years of age) accounting for 19 %, young adults (15-44 years) 58 %, and older adults (≥45 years) 23 % of reported cases. While the current case fatality proportion in West Africa is approximately 40 %, it has varied substantially over time (highest near the outbreak onset) according to available resources (40-90 % mortality in West Africa compared to under 20 % in Western Europe and the USA), by age (near universal among neonates and high among older adults), and by Ebola viral load at admission.While there is no Ebola virus-specific therapy proven to be effective in clinical trials, mortality has been dramatically lower among EVD patients managed with supportive intensive care in highly resourced settings, allowing for the avoidance of hypovolemia, correction of electrolyte and metabolic abnormalities, and the provision of oxygen, ventilation, vasopressors, and dialysis when indicated. This experience emphasizes that, in addition to evaluating specific medical treatments, improving the global capacity to provide supportive critical care to patients with EVD may be the greatest opportunity to improve patient outcomes.
authors.affiliation: Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Leligdowicz
authors.affiliation: Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Fischer
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Uyeki
authors.affiliation: Defence Medical Services, Whittington Barracks, Lichfield, UK.|Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Fletcher
authors.affiliation: Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.|Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Neill K J
authors.initials: NK
authors.lastname: Adhikari
authors.affiliation: Emergency NGO, Milan, Italy.
authors.forename: Gina
authors.initials: G
authors.lastname: Portella
authors.affiliation: Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Francois
authors.initials: F
authors.lastname: Lamontagne
authors.affiliation: Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Clement
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Shevin T
authors.initials: ST
authors.lastname: Jacob
authors.affiliation: Department of Medicine, University of Maryland, Baltimore, MD, USA.
authors.forename: Lewis
authors.initials: L
authors.lastname: Rubinson
authors.affiliation: Centre de recherche de l'institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada.
authors.forename: Abel
authors.initials: A
authors.lastname: Vanderschuren
authors.affiliation: Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Jan
authors.initials: J
authors.lastname: Hajek
authors.affiliation: Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Murthy
authors.forename: Mauricio
authors.initials: M
authors.lastname: Ferri
authors.affiliation: Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Ian
authors.initials: I
authors.lastname: Crozier
authors.affiliation: Department of Infectious and Parasitic Diseases, Donka Hospital, Conakry, Guinea.
authors.forename: Elhadj
authors.initials: E
authors.lastname: Ibrahima
authors.affiliation: Department of Infectious and Parasitic Diseases, Donka Hospital, Conakry, Guinea.
authors.forename: Marie-Claire
authors.initials: MC
authors.lastname: Lamah
authors.affiliation: Department of Pediatrics, School of Medicine and School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Schieffelin
authors.affiliation: Department of Preventive Medicine and Biometrics, Uniformed Services University, Bethesda, MD, USA.
authors.forename: David
authors.initials: D
authors.lastname: Brett-Major
authors.affiliation: Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Bausch
authors.affiliation: Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Nikki
authors.initials: N
authors.lastname: Shindo
authors.affiliation: Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Adrienne K
authors.initials: AK
authors.lastname: Chan
authors.affiliation: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: O'Dempsey
authors.affiliation: Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Sharmistha
authors.initials: S
authors.lastname: Mishra
authors.affiliation: Department of Infection, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Jacobs
authors.affiliation: Acute Medicine and Intensive Care, Derriford Hospital, Plymouth, UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Dickson
authors.affiliation: Department of Infectious Diseases, Emory University Hospital, Atlanta, Georgia, USA.
authors.forename: G Marshall
authors.initials: GM
authors.lastname: Lyon
authors.affiliation: Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada. rob.fowler@sunnybrook.ca.|Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. rob.fowler@sunnybrook.ca.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fowler
mesh_terms: D000328:Adult; D000354:Africa, Western / Q000453:epidemiology; D000368:Aged; D003422:Critical Care / Q000379:methods / Q000592:standards; D016638:Critical Illness / Q000401:mortality; D003906:Developing Countries; D029043:Ebolavirus / Q000472:pathogenicity; D005260:Female; D019142:Hemorrhagic Fever, Ebola; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Critical care; Ebola