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Critical Care for Multiple Organ Failure Secondary to Ebola Virus Disease in the United States*

Sueblinvong, Viranuj MD1; Johnson, Daniel W. MD2; Weinstein, Gary L. MD, FCCP3; Connor, Michael J. Jr MD1,4; Crozier, Ian MD5; Liddell, Allison M. MD6; Franch, Harold A. MD4; Wall, Bruce R. MD7; Kalil, Andre C. MD8; Feldman, Mark MD9; Lisco, Steven J. MD, FCCM2; Sevransky, Jonathan E. MD, MHS, FCCM1

doi: 10.1097/CCM.0000000000001197
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Objective: This report describes three patients with Ebola virus disease who were treated in the United States and developed for severe critical illness and multiple organ failure secondary to Ebola virus infection. The patients received mechanical ventilation, renal replacement therapy, invasive monitoring, vasopressor support, and investigational therapies for Ebola virus disease.

Data Sources: Patient medical records from three tertiary care centers (Emory University Hospital, University of Nebraska Medical Center, and Texas Health Presbyterian Dallas Hospital).

Study Selection: Not applicable.

Data Extraction: Not applicable.

Data Synthesis: Not applicable.

Conclusion: In the severe form, patients with Ebola virus disease may require life-sustaining therapy, including mechanical ventilation and renal replacement therapy. In conjunction with other reported cases, this series suggests that respiratory and renal failure may occur in severe Ebola virus disease, especially in patients burdened with high viral loads. Ebola virus disease complicated by multiple organ failure can be survivable with the application of advanced life support measures. This collective, multicenter experience is presented with the hope that it may inform future treatment of patients with Ebola virus disease requiring critical care treatment.

Supplemental Digital Content is available in the text.

1Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA.

2Division of Critical Care, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE.

3Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Texas Health Presbyterian Hospital, Dallas, TX.

4Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA.

5Infectious Diseases Institute, Mulago Hospital Complex, Kampala, Uganda.

6Department of Internal Medicine, Division of Infectious Diseases, Texas Health Presbyterian Hospital, Dallas, TX.

7Department of Internal Medicine, Renal Section, Texas Health Presbyterian Hospital, Dallas, TX.

8Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE.

9Department of Internal Medicine, Texas Health Presbyterian Hospital, Dallas, TX.

*See also p. 2249.

This work was performed at Emory University Hospital, Atlanta, GA; University of Nebraska Medical Center, Omaha, NE; Texas Health Presbyterian Hospital, Dallas, TX.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Sueblinvong received support for article research from the National Institutes of Health (NIH) and is employed by the Emory University. She received support from the NIH/National Institute of Alcohol Abuse and Alcoholism (K08 AA021404-01). Her institution received grant support from the NIH (K08). Dr. Weinstein consulted for GlaxoSmithKline and Pfizer (continuing medical education talks) and provided expert testimony for various law firms. Dr. Connor received support for travel from AKI & CRRT 2015 Conference (February 2015) (partial reimbursement of travel expenses for presentation on acute management of Ebola virus disease). Dr. Liddell is employed by the Texas Health Physicians Group. Dr. Wall received support for the development of educational presentations from the Presbyterian Hospital (Chief of Nephrology, paid to organize lectures). The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: vsuebli@emory.edu

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