Feb 17, 2018 Volume 391 Number 10121 p631-712
Evidence-based guidelines for supportive care of patients with Ebola virus disease
François Lamontagne, Robert A Fowler, Neill K Adhikari, Srinivas Murthy, David M Brett-Major, Michael Jacobs, Timothy M Uyeki, Constanza Vallenas, Susan L Norris, William A Fischer 2nd, Thomas E Fletcher, Adam C Levine, Paul Reed, Daniel G Bausch, Sandy Gove, Andrew Hall, Susan Shepherd, Reed A Siemieniuk, Marie-Claude Lamah, Rashida Kamara, Phiona Nakyeyune, Moses J Soka, Ama Edwin, Afeez A Hazzan, Shevin T Jacob, Mubarak Mustafa Elkarsany, Takuya Adachi, Lynda Benhadj, Christophe Clément, Ian Crozier, Armando Garcia, Steven J Hoffman, Gordon H Guyatt
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.