Evidence-Based Guidelines for Supportive Care in Ebola Treatment
Case fatality rates in West Africa were initially greater than 70%, but decreased with improvements in supportive care. Photo Credit: CDC/Dr Fred Murphy.
The West African Ebola outbreak of 2013 through 2016 highlighted some major challenges in the region's ability to provide care for people with Ebola. In response, researchers developed an evidence-based guideline for supportive care of patients with Ebola in resource-limited settings using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Final recommendations were published in the Lancet.
A 34-person multidisciplinary panel was assembled and voted on 8 recommendations. The panel steering committee used interviews and surveys of health workers involved in the West African Ebola outbreak response to determine the questions these guidelines would address.
The panel was strongly in favor of recommendations receiving 80% or more votes and conditionally in favor of those receiving less. Confidence of each recommendation was rated low, moderate, or high based on the quality of supporting evidence and the magnitude of benefit vs harm. They also specified value and preference judgments. For example, high value was given to uncertain, substantial mortality reduction and lower value to uncertain Ebola virus transmission.
The use of analgesic therapy for pain management, including opioids if necessary, was strongly recommended with high confidence. Oral and, when necessary, parenteral rehydration, staffing ratios of 1 clinician to 4 patients, and the prompt administration of broad-spectrum antibiotics in patients with high severity of illness were strongly recommended with moderate confidence.
Serum biochemistry testing and systematic monitoring and charting of vital signs and volume levels were strongly recommended with low confidence, and communication with family and friends of patients admitted to isolation wards was conditionally recommended with low confidence.
“Applying these recommendations could not only improve outcomes but enable data collection that will inform future practice,” concluded the researchers.
A detailed description of the 8 recommendations can be viewed here.
Lamontagne F, Fowler RA, Adhikari NK, et al. Evidence-based guidelines for supportive care of patients with Ebola virus disease. [published online October 17, 2017]. Lancet. doi: 10.1016/S0140-6736(17)31795-6