J Anesth Perioper Med. 2016;3(6):270-275. https://doi.org/10.24015/ebcmed.japm.2016.0036
From 1Department of Anesthesiology, Austin Health, Victoria, Australia; 2Department of Anesthesiology, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada.
Correspondence to Dr. David T. Wong at David.wong@uhn.ca.
EBCMED ID: ebcmed.japm.2016.0036 DOI: 10.24015/ebcmed.japm.2016.0036
Aim of reviewThe 2014-2015 outbreak of Ebola Virus Disease (EVD) in West Africa is the largest in history. This outbreak resulted in the deaths of more than 11,000 people. Although the vast majority of cases occurred in the West African countries of Sierra Leone, Guinea and Liberia, a number of patients were also cared for in Europe and North America. This review gives an overview of the clinical features and management of patients with EVD with emphasis on respiratory symptoms and airway management. Although Ebola is not commonly associated with respiratory conditions, a number of patients required intubation during the recent epidemic.
Methods
Recent literature and guidelines were reviewed and the management of EVD patients with respiratory symptoms was discussed with particular emphasis on those managed outside of West Africa.
Recent findings
A total of 27 patients were cared for in the United States and Europe during the 2014-2015 epidemic. Of these, 9 patients progressed to either noninvasive or invasive mechanical ventilation. Respiratory symptoms are more commonly seen in patients encountered in Northern America and Europe when compared to West Africa. This is possibly related to higher volumes of fluid administration in these patients. Although Ebola is not an airborne virus, airway maneuvers such as bag-mask ventilation and intubation can result in generation of aerosolized saliva or other fluids containing the virus. This is a high risk time for transmission to health care workers and extra precautions are required. The addition of airborne precautions, either a powered air purification respirator system (PAPR) or N95 mask, to standard personal protective equipment is suggested when providing airway management to patients with Ebola. There should be consideration of rapid sequence induction and avoidance of bag-mask ventilation to reduce the risk of aerosolization of virus. Patients with a potentially difficult airway require special consideration.
Summary
The recent outbreak of Ebola virus disease tested the preparedness of many hospitals, including those in Europe and North America. When caring for patients with Ebola, staff protection and avoidance of transmission of virus to healthcare workers is paramount.
Article Type
Review Article
Declaration of Interests
No potential conflict of interest relevant to this article was reported.
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