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Intensive care support and clinical outcomes of patients with Ebola virus disease (EVD) in West Africa.

ABSTRACT: PURPOSE:We investigate the impact on outcome of different levels of supportive treatment in Ebola virus disease (EVD). The NGO EMERGENCY delivered care sequentially at two Ebola Treatment Centres (ETC) in Sierra Leone: first at Lakka (fluids, symptomatic, antibiotic, antimalaria treatment, and hospital level medical care), and thereafter in Goderich, adding organ support in the only African ETC with an equipped and staffed intensive care unit (ETC-ICU). METHODS:The primary outcome in this retrospective cohort study was in-ETC mortality. Secondarily, we used multivariable logistic regression to investigate the independent impact of the IC on mortality by comparing patients in two ETCs, adjusting for potential confounders, including the viral load (base-10 logarithm in copies/ml) (LVL), modelled as a piecewise linear function. Mortality was plotted versus LVL. Confidence bands were constructed by a bootstrap technique. The number of hospital-free days within 28 was computed to assess the burden of EVD. RESULTS:Data from 229 EVD patients were analysed (123 in Lakka, 106 in Goderich). Crude analysis showed a non-statistically significant difference in mortality (57.7% in Lakka vs 50.0% in Goderich; p?=?0.19). Age and LVL were associated with mortality. Adjusted mortality was lower at the Goderich ICU-ETC (p?=?0.055). This difference was observed with 80% confidence for patients with LVL between 7.5 and 8.5 copies/ml. Hospital-free days (of 28 days) were greater (7.7 vs 5.5; p?=?0.03) for patients treated in the ICU-ETC. CONCLUSIONS:Provision of critical care to patients with EVD is feasible in resource-limited settings and was associated with improved survival and less time in hospital.

SUBMITTER: Langer M

PROVIDER: S-EPMC6096698 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Intensive care support and clinical outcomes of patients with Ebola virus disease (EVD) in West Africa.

Langer Martin M Portella Gina G Finazzi Stefano S Chatenoud Liliane L Lanini Simone S Vairo Francesco F Fowler Robert R Miccio Rossella R Ippolito Giuseppe G Bertolini Guido G Strada Gino G

Intensive care medicine 20180730 8

<h4>Purpose</h4>We investigate the impact on outcome of different levels of supportive treatment in Ebola virus disease (EVD). The NGO EMERGENCY delivered care sequentially at two Ebola Treatment Centres (ETC) in Sierra Leone: first at Lakka (fluids, symptomatic, antibiotic, antimalaria treatment, and hospital level medical care), and thereafter in Goderich, adding organ support in the only African ETC with an equipped and staffed intensive care unit (ETC-ICU).<h4>Methods</h4>The primary outcome ...[more]

PMID: 30062576

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Project description:BackgroundDuring the 2013-2016 West Africa Ebola outbreak, supportive care was the only non-experimental treatment option for patients with Ebola virus disease (EVD). However, providing care that would otherwise be routine for most clinical settings in the context of a highly contagious and lethal pathogen is much more challenging. The objective of this study was to document and deepen understanding of barriers to provision of supportive care in Ebola treatment units (ETUs) as perceived by those involved in care delivery during the outbreak.MethodsThis qualitative study consisted of 29 in-depth semi-structured interviews with stakeholders (decision-makers, physicians, nurses) involved in patient care delivery during the outbreak. Analysis consisted of interview debriefing and team-based transcript coding in NVivo10 software using thematic analysis.FindingsParticipants emphasized three interconnected barriers to providing high-quality supportive care during the outbreak: 1) lack of material and human resources in ETUs; 2) ETU organizational structure limiting the provision of supportive clinical care; and 3) delayed and poorly coordinated policies limiting the effectiveness of global and national responses. Participants also noted the ethical complexities of defining and enacting best clinical practices in low-income countries. They noted tension between, on one hand, scaling up minimal care and investing in clinical care preparedness to a level sustainable in West Africa and, on the other, providing a higher level of supportive care, which in low-resource health systems would require important investments.ConclusionOur findings identified potentially modifiable barriers to the delivery of supportive care to patients with EVD in West Africa. Addressing these in the inter-outbreak period will be useful to improve patient care and outcomes during inevitable future outbreaks. Promoting community trust and engagement through long-term capacity building of the healthcare workforce and infrastructure would increase both health system resilience and ability to handle other outbreaks of emerging diseases.

Dataset Information

Intensive care support and clinical outcomes of patients with Ebola virus disease (EVD) in West Africa.

Publications

Intensive care support and clinical outcomes of patients with Ebola virus disease (EVD) in West Africa.

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