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Lessons Learned

Critical Care Management of Patients With Ebola in the United States*

Johnson, Daniel W. MD1; Sullivan, James N. MD1; Piquette, Craig A. MD2; Hewlett, Angela L. MD3; Bailey, Kristina L. MD2; Smith, Philip W. MD3; Kalil, Andre C. MD3; Lisco, Steven J. MD, FCCM1

doi: 10.1097/CCM.0000000000000935
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Objective: This report will describe the preparations for and the provision of care of two patients with Ebola virus disease in the biocontainment unit at the University of Nebraska Medical Center.

Data Sources: Patient medical records.

Study Selection: Not applicable.

Data Extraction: Not applicable.

Data Synthesis: Not applicable.

Conclusions: Safe and effective care of patients with Ebola virus disease requires significant communication and planning. Adherence to a predetermined isolation protocol is essential, including proper donning and doffing of personal protective equipment. Location of the patient care area and the logistics of laboratory testing, diagnostic imaging, and the removal of waste must be considered. Patients with Ebola virus disease are often dehydrated and need adequate vascular access for fluid resuscitation, nutrition, and phlebotomy for laboratory sampling. Advanced planning for acute life-threatening events and code status must be considered. Intensivist scheduling should account for the significant amount of time required for the care of patients with Ebola virus disease. With appropriate precautions and resources, designated hospitals in the United States can safely provide care for patients with Ebola virus disease.

1Division of Critical Care, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE.

2Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE.

3Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE.

* See also p. 1326.

This work was performed at University of Nebraska Medical Center, Omaha, NE.

Supported, in part, by the University of Nebraska Medical Center.

Dr. Piquette has disclosed government work. Dr. Hewlett’s institution received grant support from Pfizer (orthopedic infections research grant). Dr. Lisco served as a board member for the University of Nebraska Medical Center Physicians and the Association of Midwest Academic Anesthesiology (Chairman); is employed by the University of Nebraska Medical Medical Center and the University of Nebraska Medical Center Physicians; was employed in the past by the University of Cincinnati and the University of Cincinnati Physicians; and has patents with RADLyn, LLC (US 2008/0066746 A1: Nelson LA; Lisco SJ: Method and Device for Placing an Endoctracheal Tube. Patent approved 11/2010). He provided expert testimony for Calderhead, Lockemeyer & Peschke; ROTHBERG LOGAN & WARSCO; PROCHASKA, GIROUX, AND HOWELL; Williams, Hall & Latherow; McGOWAN & JACOBS; Wellman, Nichols & Smith; Martin F. White, Co, LPA; and Dellecker, Wilson, King, McKenna, Ruffier, & Sos. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: dan.johnson@unmc.edu

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