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Nawathe P, Garland J, Cuzzolina J, Salinas N, Dodd B, Grein J. Simulation as Proof of Concept to Assess the Feasibility and Address Uncertainties Regarding Cardiopulmonary Resuscitation in an Adolescent Patient With Viral Hemorrhagic Fever. Simul Healthc 2024:01266021-990000000-00140. [PMID: 39133109 DOI: 10.1097/sih.0000000000000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
INTRODUCTION While general management guidelines exist for patients with viral hemorrhagic fevers (VHF), uncertainty surrounds the extent to which critical care interventions should be provided. There has been significant concern in providing cardiopulmonary resuscitation (CPR) to a patient with VHF due to concerns regarding CPR efficiency and the safety of the healthcare team. However, data on CPR feasibility, efficiency, and latent safety threats (LSTs) to the healthcare team in patients with VHF needing CPR are lacking. Our team proactively studied this in the simulation environment as the first step to guiding evidence-based and ethically informed decisions about CPR for these patients. METHODS We studied CPR metrics, times to critical interventions, and LSTs using systems-focused debriefing in an adolescent patient with VHF who had pulseless electrical activity. This exercise included 3 members inside the patient room in full PPE and special pathogens team members in modified PPE outside the room. RESULTS We found that CPR is feasible in full PPE. The chest compression fraction was 72%, with an average manual rate of 129 compressions per minute and an average manual depth of 2.1 inches. We identified multiple LSTs in the debriefing and video analysis. CONCLUSIONS This simulation study showed that CPR in a patient with VHF is possible in full PPE with a minimum of 3 team members. However, we identified physical and psychological LSTs with the systems-focused debriefing. Therefore, refining roles and responsibilities would be necessary to improve the safety of the healthcare team and improve the quality of CPR.
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Affiliation(s)
- Pooja Nawathe
- From the Guerin Children's, Department of Pediatrics (P.W.); Special Pathogens Program (J.G., J.C.); Department of Emergency Medicine (N.S.); Women's Guild Simulation Center for Advanced Clinical Skills and Innovation (B.D.); and Hospital Epidemiology (J.G.), Cedars-Sinai Medical Center, Los Angeles, CA
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Healthcare workers' infection risk perceptions of aerosol-generating procedures and affective response. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e29. [PMID: 36865705 PMCID: PMC9972538 DOI: 10.1017/ash.2022.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 02/17/2023]
Abstract
Objective To understand healthcare worker (HCW) perceptions of infection risk associated with aerosol-generating procedures (AGPs) and their affective response to performing AGPs. Design Systematic review. Methods Systematic searches of PubMed, CINHAL Plus, and Scopus were conducted using combinations of selected keywords and synonyms. To reduce bias, titles and abstracts were screened for eligibility by 2 independent reviewers. Also, 2 independent reviewers extracted data from each eligible record. Discrepancies were discussed until consensus was reached. Results In total, 16 reports from across the globe were included in this review. Findings suggest that AGPs are generally perceived to place HCWs at high risk of becoming infected with respiratory pathogens and that this perception stimulates a negative affective response and hesitancy to participate in the procedures. Conclusions AGP risk perception are complex and context dependent but have important influences on HCW infection control practices, decision to participate in AGPs, emotional welfare, and workplace satisfaction. New and unfamiliar hazards paired with uncertainty lead to fear and anxiety about personal and others' safety. These fears may create a psychological burden conducive to burnout. Empirical research is needed to thoroughly understand the interplay between HCW risk perceptions of distinct AGPs, their affective responses to conducting these procedures under various conditions, and their resulting decision to participate in these procedures. Results from such studies are essential for advancing clinical practice; they point to methods for mitigating provider distress and better recommendations for when and how to conduct AGPs.
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Abstract
Cardiopulmonary resuscitation (CPR) is an emergency lifesaving endeavor, performed in either the hospital or outpatient settings, that significantly improves outcomes and survival rates when performed in a timely fashion. As with any other medical procedure, CPR can bear potential risks not only for the patient but also for the rescuer. Among those risks, transmission of an infectious agent has been one of the most compelling triggers of reluctance to perform CPR among providers. The concern for transmission of an infection from the resuscitated subject may impede prompt initiation and implementation of CPR, compromising survival rates and neurological outcomes of the patients. Infections during CPR can be potentially acquired through airborne, droplet, contact, or hematogenous transmission. However, only a few cases of infection transmission have been actually reported globally. In this review, we present the available epidemiological findings on transmission of different pathogens during CPR and data on reluctance of health care workers to perform CPR. We also outline the levels of personal protective equipment and other protective measures according to potential infectious hazards that providers are potentially exposed to during CPR and summarize current guidelines on protection of CPR providers from international societies and stakeholders.
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A Multicenter Evaluation of Survival After In-Hospital Cardiac Arrest in Coronavirus Disease 2019 Patients. Crit Care Explor 2021; 3:e0425. [PMID: 34036276 PMCID: PMC8133239 DOI: 10.1097/cce.0000000000000425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE: In-hospital cardiac arrest survival among coronavirus disease 2019 patients has been reported to range from 0% to 12%. These numbers are significantly lower than reported prepandemic in-hospital cardiac arrest survival rates of approximately 20–25% in the United States for non–coronavirus disease 2019 patients. OBJECTIVE: To assess the incidence of in-hospital cardiac arrest survival of coronavirus disease 2019 patients. DESIGN: A retrospective cohort study of adult patients with coronavirus disease 2019 subsequently found to have in-hospital cardiac arrest and underwent cardiopulmonary resuscitation (cardiopulmonary resuscitation). SETTING: Multiple hospitals of the Cleveland Clinic Health System. PATIENTS: All adult patients (age ≥ 18 yr) admitted to Cleveland Clinic Health System with a diagnosis of coronavirus disease 2019 who experienced in-hospital cardiac arrest requiring cardiopulmonary resuscitation. MEASUREMENTS AND MAIN RESULTS: From March 01, 2020 to October 15, 2020, 3,555 patients with coronavirus disease 2019 were hospitalized; 1,372 were admitted to the ICU; 58 patients had in-hospital cardiac arrest. Median age of this cohort was 66.5 years (interquartile range, 55.0–76.0 yr). Patients were predominantly male (62.5%), White (53.4%), with a median body mass index of 29.7 (interquartile range, 25.8–34.6). Most in-hospital cardiac arrests were in critical care environments (ICU), 51 of 58 (87.9%); seven of 58 (12.1%) were on ward locations. Thirty-four of 58 patients (58.6%) were on mechanical ventilation prior to in-hospital cardiac arrest with a median duration of mechanical ventilation of 9 days (interquartile range, 2–18 d). Twenty-four of 58 patients (44%) were on vasopressors prior to arrest. Initial arrest rhythm was pulseless electrical activity at (63.8%), asystole (29.3%), and pulseless ventricular tachycardia/fibrillation (6.9%). Of the 58 patients, 35 (60.3%) attained return of spontaneous circulation, and 13 of 58 (22.4%) were discharged alive. CONCLUSIONS: We report a 22% survival to discharge after in-hospital cardiac arrest in coronavirus disease 2019 patients, a survival rate similar to before the coronavirus disease 2019 pandemic.
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Shurlock J, Rudd J, Jeanes A, Iacovidou A, Creta A, Kanthasamy V, Schilling R, Sullivan E, Cooke J, Laws-Chapman C, Baxter D, Finlay M. Communication in the intensive care unit during COVID-19: early experience with the Nightingale Communication Method. Int J Qual Health Care 2021; 33:6018447. [PMID: 33270866 PMCID: PMC7799099 DOI: 10.1093/intqhc/mzaa162] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/15/2020] [Accepted: 12/03/2020] [Indexed: 11/16/2022] Open
Abstract
Objective To assess the utility and frequency of use of the Nightingale Communication Method, during the early operational phase of the Nightingale Hospital London (NHL) 4000-bed field hospital’s intensive care unit. Design Survey-based cross-sectional assessment. Setting The intensive care unit at the Nightingale London hospital. Participants Staff working in the clinical area and therefore requiring full personal protective equipment (PPE). Intervention Survey of all staff members sampled from a single shift at the Nightingale Hospital. This investigated perceived utility and actual use of identification methods (name and role labels on visors and gowns, coloured role identification tapes) and formal hand signals as an adjunctive communication method. Main Outcome Measure Self-reported frequency of use and perceived utility of each communication and personnel identification adjunct. Results Fifty valid responses were received (72% response rate), covering all clinical professional groups. Prominent name/role identifications and coloured role identification tapes were very frequently used and were perceived as being highly useful. Formal hand signals were infrequently used and not perceived as being beneficial, with respondents citing use of individual hand signals only in specific circumstances. Conclusion PPE is highly depersonalizing, and interpersonal identification aids are very useful. Despite being difficult, verbal communication is not completely prohibited, which could explain the low utility of formal hand signals. The methods developed at the Nightingale hospital have enhanced communication in the critical care, field hospital setting. There is potential for wider application to a variety of healthcare settings, in both the current situation and future pandemic scenarios.
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Affiliation(s)
- Jonathan Shurlock
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
| | - James Rudd
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
| | - Annette Jeanes
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
| | - Aphrodite Iacovidou
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
| | - Antonio Creta
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
| | | | - Richard Schilling
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
| | - Eamonn Sullivan
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
| | - Joanne Cooke
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
| | - Colette Laws-Chapman
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
| | - David Baxter
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
| | - Malcolm Finlay
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
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Institutional policies and readiness in management of critical illness among patients with viral hemorrhagic fever. Infect Control Hosp Epidemiol 2021; 42:1307-1312. [PMID: 33583468 DOI: 10.1017/ice.2020.1416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE In response to the 2013-2016 Ebola virus disease outbreak, the US government designated certain healthcare institutions as Ebola treatment centers (ETCs) to better prepare for future emerging infectious disease outbreaks. This study investigated ETC experiences and critical care policies for patients with viral hemorrhagic fever (VHF). DESIGN A 58-item questionnaire elicited information on policies for 9 critical care interventions, factors that limited care provision, and innovations developed to deliver care. SETTING AND PARTICIPANTS The questionnaire was sent to 82 ETCs. METHODS We analyzed ordinal and categorical data pertaining to the ETC characteristics and descriptive data about their policies and perceived challenges. Statistical analyses assessed whether ETCs with experience caring for VHF patients were more likely to have critical care policies than those that did not. RESULTS Of the 27 ETCs who responded, 17 (63%) were included. Among them, 8 (47%) reported experience caring for persons under investigation or confirmed cases of VHF. Most felt ready to provide intubation, chest compressions, and renal replacement therapy to these patients. The factors most cited for limiting care were staff safety and clinical futility. Innovations developed to better provide care included increased simulation training and alternative technologies for procedures and communication. CONCLUSIONS There were broad similarities in critical care policies and limitations among institutions. There were several interventions, namely ECMO and cricothyrotomy, which few institutions felt ready to provide. Future studies could identify obstacles to providing these interventions and explore policy changes after increased experience with novel infectious diseases, such as COVID-19.
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Miles JA, Mejia M, Rios S, Sokol SI, Langston M, Hahn S, Leiderman E, Salgunan R, Soghier I, Gulani P, Joshi K, Chung V, Morante J, Maggiore D, Uppal D, Friedman A, Katamreddy A, Abittan N, Ramani G, Irfan W, Liaqat W, Grushko M, Krouss M, Cho HJ, Bradley SM, Faillace RT. Characteristics and Outcomes of In-Hospital Cardiac Arrest Events During the COVID-19 Pandemic: A Single-Center Experience From a New York City Public Hospital. Circ Cardiovasc Qual Outcomes 2020; 13:e007303. [PMID: 32975134 PMCID: PMC7673640 DOI: 10.1161/circoutcomes.120.007303] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Patients hospitalized for severe coronavirus disease 2019 (COVID-19) infection are at risk for in-hospital cardiac arrest (IHCA). It is unknown whether certain characteristics of cardiac arrest care and outcomes of IHCAs during the COVID-19 pandemic differed compared with a pre-COVID-19 period. Methods: All patients who experienced an IHCA at our hospital from March 1, 2020 through May 15, 2020, during the peak of the COVID-19 pandemic, and those who had an IHCA from January 1, 2019 to December 31, 2019 were identified. All patient data were extracted from our hospital’s Get With The Guidelines–Resuscitation registry, a prospective hospital-based archive of IHCA data. Baseline characteristics of patients, interventions, and overall outcomes of IHCAs during the COVID-19 pandemic were compared with IHCAs in 2019, before the COVID-19 pandemic. Results: There were 125 IHCAs during a 2.5-month period at our hospital during the peak of the COVID-19 pandemic compared with 117 IHCAs in all of 2019. IHCAs during the COVID-19 pandemic occurred more often on general medicine wards than in intensive care units (46% versus 33%; 19% versus 60% in 2019; P<0.001), were overall shorter in duration (median time of 11 minutes [8.5–26.5] versus 15 minutes [7.0–20.0], P=0.001), led to fewer endotracheal intubations (52% versus 85%, P<0.001), and had overall worse survival rates (3% versus 13%; P=0.007) compared with IHCAs before the COVID-19 pandemic. Conclusions: Patients who experienced an IHCA during the COVID-19 pandemic had overall worse survival compared with those who had an IHCA before the COVID-19 pandemic. Our findings highlight important differences between these 2 time periods. Further study is needed on cardiac arrest care in patients with COVID-19.
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Affiliation(s)
- Jeremy A Miles
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx.,Division of Cardiology, Montefiore Medical Center (J.A.M.), Albert Einstein College of Medicine, Bronx
| | - Mateo Mejia
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Saul Rios
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Seth I Sokol
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Matthew Langston
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Steven Hahn
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Ephraim Leiderman
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Reka Salgunan
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Israa Soghier
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Perminder Gulani
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Keval Joshi
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Virginia Chung
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Joaquin Morante
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Diane Maggiore
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Dipan Uppal
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Ari Friedman
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Adarsh Katamreddy
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Nathaniel Abittan
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Gokul Ramani
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Wakil Irfan
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Wasla Liaqat
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Michael Grushko
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
| | - Mona Krouss
- Department of Quality and Safety, NYC Health and Hospitals (M.K., H.J.C.).,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (M.K.)
| | - Hyung J Cho
- Department of Quality and Safety, NYC Health and Hospitals (M.K., H.J.C.).,Department of Medicine, NYU Grossman School of Medicine (H.J.C.)
| | - Steven M Bradley
- Cardiology and Healthcare Delivery Innovation Center, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (S.M.B.)
| | - Robert T Faillace
- Department of Medicine, NYC Health and Hospitals/Jacobi (J.A.M., M.M., S.R., S.I.S., M.L., S.H., E.L., R.S., I.S., P.G., K.J., V.C., J.M., D.M., D.U., A.F., A.K., N.A., G.R., W.I., W.L., M.G., R.T.F.), Albert Einstein College of Medicine, Bronx
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Song W, Liu Y, Ouyang Y, Chen W, Li M, Xianyu S, Yi S. Recommendations on cardiopulmonary resuscitation strategy and procedure for novel coronavirus pneumonia. Resuscitation 2020; 152:52-55. [PMID: 32276002 PMCID: PMC7141461 DOI: 10.1016/j.resuscitation.2020.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Wei Song
- Department of Emergency, Hainan General Hospital, 19 Xiuhua Road, Haikou, Hainan 570311, China
| | - Yuanshui Liu
- Department of Emergency, Hainan General Hospital, 19 Xiuhua Road, Haikou, Hainan 570311, China
- Department of Respiratory and Critical Care Medicine, Key Cite of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
| | - Yanhong Ouyang
- Department of Emergency, Hainan General Hospital, 19 Xiuhua Road, Haikou, Hainan 570311, China
| | - Wenteng Chen
- Department of Emergency, Hainan General Hospital, 19 Xiuhua Road, Haikou, Hainan 570311, China
| | - Min Li
- Department of Emergency, Hainan General Hospital, 19 Xiuhua Road, Haikou, Hainan 570311, China
| | - Shuming Xianyu
- Department of Emergency, Hainan General Hospital, 19 Xiuhua Road, Haikou, Hainan 570311, China
| | - Shengyang Yi
- Department of Emergency, Hainan General Hospital, 19 Xiuhua Road, Haikou, Hainan 570311, China
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Jacob ST, Crozier I, Fischer WA, Hewlett A, Kraft CS, Vega MADL, Soka MJ, Wahl V, Griffiths A, Bollinger L, Kuhn JH. Ebola virus disease. Nat Rev Dis Primers 2020; 6:13. [PMID: 32080199 PMCID: PMC7223853 DOI: 10.1038/s41572-020-0147-3] [Citation(s) in RCA: 296] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2020] [Indexed: 12/16/2022]
Abstract
Ebola virus disease (EVD) is a severe and frequently lethal disease caused by Ebola virus (EBOV). EVD outbreaks typically start from a single case of probable zoonotic transmission, followed by human-to-human transmission via direct contact or contact with infected bodily fluids or contaminated fomites. EVD has a high case-fatality rate; it is characterized by fever, gastrointestinal signs and multiple organ dysfunction syndrome. Diagnosis requires a combination of case definition and laboratory tests, typically real-time reverse transcription PCR to detect viral RNA or rapid diagnostic tests based on immunoassays to detect EBOV antigens. Recent advances in medical countermeasure research resulted in the recent approval of an EBOV-targeted vaccine by European and US regulatory agencies. The results of a randomized clinical trial of investigational therapeutics for EVD demonstrated survival benefits from two monoclonal antibody products targeting the EBOV membrane glycoprotein. New observations emerging from the unprecedented 2013-2016 Western African EVD outbreak (the largest in history) and the ongoing EVD outbreak in the Democratic Republic of the Congo have substantially improved the understanding of EVD and viral persistence in survivors of EVD, resulting in new strategies toward prevention of infection and optimization of clinical management, acute illness outcomes and attendance to the clinical care needs of patients.
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Affiliation(s)
- Shevin T Jacob
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Global Health Security Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Ian Crozier
- Integrated Research Facility at Fort Detrick, Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research supported by the National Cancer Institute, Frederick, MD, USA
| | - William A Fischer
- Department of Medicine, Division of Pulmonary Disease and Critical Care Medicine, Chapel Hill, NC, USA
| | - Angela Hewlett
- Nebraska Biocontainment Unit, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Colleen S Kraft
- Microbiology Section, Emory Medical Laboratory, Emory University School of Medicine, Atlanta, GA, USA
| | - Marc-Antoine de La Vega
- Department of Microbiology, Immunology & Infectious Diseases, Université Laval, Quebec City, QC, Canada
| | - Moses J Soka
- Partnership for Ebola Virus Disease Research in Liberia, Monrovia Medical Units ELWA-2 Hospital, Monrovia, Liberia
| | - Victoria Wahl
- National Biodefense Analysis and Countermeasures Center, Fort Detrick, Frederick, MD, USA
| | - Anthony Griffiths
- Department of Microbiology and National Emerging Infectious Diseases Laboratories, Boston University School of Medicine, Boston, MA, USA
| | - Laura Bollinger
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, MD, USA
| | - Jens H Kuhn
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, MD, USA.
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10
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Carvalho E, Castro P, León E, Del Río A, Crespo F, Trigo L, Fernández S, Trilla A, Varela P, Nicolás JM. Multi-professional simulation and risk perception of health care workers caring for Ebola-infected patients. Nurs Crit Care 2018; 24:256-262. [PMID: 30460729 DOI: 10.1111/nicc.12396] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 09/23/2018] [Accepted: 09/30/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Treatment of infections that require high-level isolation can cause anxiety and fear among health care workers. Adequate and complete multi-professional simulation-based training could reduce those feelings and improve patient care. OBJECTIVE The purpose of this study was to assess the impact of multi-professional simulation-based training on the risk perception and preparedness of health care workers (registered nurses, doctors and ancillary staff) who care for patients assessed to be at risk or confirmed to have Ebola, level 3-4 biohazard. METHODS A prospective before-after study was designed. Health care workers who participated in a multi-professional simulation training course to improve the care of patients potentially infected with Level 3 and 4 biohazards were evaluated about their risk perception. The training was based on clinical scenarios. The evaluation was conducted using questionnaire based on Likert scale. After the training, a satisfaction survey about the most important aspects of the course was also conducted. RESULTS Fifty-eight health care workers participated in the training course, 22 of whom were registered nurses. Participants presented positive changes after the training, increasing their sense of security, predisposition and confidence (p < 0.000001 for all). CONCLUSION Multi-professional simulation-based training significantly improves the perception of safety and preparedness of health care workers regarding the care of patients potentially infected with Ebola virus and other Level 3-4 biohazards. RELEVANCE TO CLINICAL PRACTICE The implementation of educational training strategies - such as simulations - is beneficial in improving the capacity of response and coping, as well as in reducing feelings of fear and insecurity.
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Affiliation(s)
- Eva Carvalho
- Clinical Simulation Laboratory, School of Medicine, University of Barcelona, Barcelona, Spain.,CAPES Foundation Ministry of Education of Brazil, Brasília, Brazil
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clinic of Barcelona, Spain.,IDIBAPS, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Esther León
- Clinical Simulation Laboratory, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Ana Del Río
- Infectious Diseases Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Félix Crespo
- Medical Intensive Care Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Laura Trigo
- Medical Intensive Care Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Sara Fernández
- Medical Intensive Care Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Antoni Trilla
- IDIBAPS, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Department of Preventive Medicine and Epidemiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Pilar Varela
- Department of Human Resources, Hospital Clinic of Barcelona, Barcelona, Spain.,Department of Occupational Hazard Prevention, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Jose Maria Nicolás
- IDIBAPS, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Medical Intensive Care Unit, Hospital Clinic of Barcelona, Barcelona, Spain
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11
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12
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Pierce WF, Ready SD, Chapman JT, Kulick C, Shields A, Wang J, Andrews K, Childs RW, Bell C, Kosyak A, Pham J. Essential Medications for Patients With Suspected or Confirmed Ebola Virus Disease in Resource-Limited Environments. Mil Med 2018; 182:e2006-e2016. [PMID: 28885970 DOI: 10.7205/milmed-d-17-00010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In 2014, the U.S. Public Health Service (USPHS) Commissioned Corps deployed to Monrovia, Liberia, to operate a 25-bed Ebola treatment unit (ETU) constructed by the U.S. Military. The ETU was named the Monrovia Medical Unit (MMU) and was constructed from an U.S. Air Force Expeditionary Medical Support (EMEDS) unit with modifications on the basis of consultation from Médecins Sans Frontières, the World Health Organization, and expert panels from the U.S. Department of Defense and Department of Health and Human Services. From November 12, 2014, to April 30, 2015, 42 patients (18 confirmed Ebola virus disease [EVD] and 24 suspected EVD) from nine countries were treated by USPHS providers at the MMU. The medications used in the MMU were primarily procured from the EMEDS 25-bed pharmacy cache. However, specific formulary additions were made for treatment of EVD. METHODS Using the MMU pharmacy dispensing data, we compared and contrasted the medications used in the MMU with recommendations in published EVD treatment guidelines for austere settings. FINDINGS After comparing and contrasting the MMU pharmacy dispensing data with publications with EVD medication recommendations applicable to resource-limited settings, 101 medications were included in the USPHS Essential Medications for the Management of EVD List (EML) for an austere, isolated clinical environment. DISCUSSION/IMPACT/RECOMMENDATIONS Because Ebola outbreaks often occur in remote areas, proactive planning, improved preparedness, and optimal patient care for EVD are needed, especially in the context of austere environments with a scarcity of resources. We developed the EML to assist in the planning for future Ebola outbreaks in a remote clinical environment and to provide a list of medications that have been used in an ETU. The EML is a comprehensive medication list that builds on the existing publications with EVD treatment recommendations applicable to supply-constrained clinical environments. As well, it is a resource for the provision of medications when evaluating donations, procurement, and may help inform estimates for product inventory requirements for an ETU. We hope the EML will improve readiness and enhance the capabilities of local and regional international responders.
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Affiliation(s)
- William F Pierce
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993-1058
| | - Selena D Ready
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993-1058
| | - John Tyson Chapman
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993-1058
| | - Corrinne Kulick
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993-1058
| | - Anastasia Shields
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993-1058
| | - Jialynn Wang
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993-1058
| | - Kimberly Andrews
- Phoenix Indian Medical Center, 4212 North 16th Street, Phoenix, AZ 85016-5389
| | - Richard W Childs
- National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892
| | - Carlos Bell
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993-1058
| | - Alexandr Kosyak
- Centers for Disease Control and Prevention, 1600 Clifton Avenue, Atlanta, GA 30333
| | - Jade Pham
- U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993-1058
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13
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Drewry DG, Sauer LM, Shaw-Saliba K, Therkorn J, Rainwater-Lovett K, Pilholski T, Garibaldi BT. Identifying Potential Provider and Environmental Contamination on a Clinical Biocontainment Unit Using Aerosolized Pathogen Simulants. Health Secur 2018; 16:83-91. [PMID: 29624490 DOI: 10.1089/hs.2017.0064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The Johns Hopkins Hospital created a biocontainment unit (BCU) to care for patients with highly infectious diseases while assuring healthcare worker safety. Research to date for BCU protocols and practices are based on case reports and lessons learned from patient care and exercises. This study seeks to be the first to explore the influences of healthcare worker movement and personal protective equipment (PPE) doffing on the transport of simulant pathogen particles in a BCU. A cough device released 1 μm fluorescent polystyrene beads (PSLs) in the patient room. PSL transport was then examined under 2 scenarios: (1) PSL release only, no healthcare workers; and (2) PSL release during 5-minute simulated activity by healthcare workers. Airborne PSL concentrations were quantified every second for 30 minutes per scenario by 7 optical particle sensors located throughout the BCU. PSLs were not detected in the donning room at any time nor in the doffing room during the first test scenario where no healthcare worker was present. The main difference detected between the tested scenarios was the presence of PSLs in the doffing room when healthcare workers were removing PPE, potentially due to re-aerosolization of PSLs off the exterior PPE surface or opening of the patient room door. Future work will further explore the potential for re-aerosolization of particles off of PPE during doffing. The present study provides the groundwork for a systematic method for evaluating the BCU and doffing procedures for their respective safety, and it also pilots a systematic method for evaluating potential pathogen exposure pathways for BCU healthcare workers.
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Abstract
The recent Ebola virus disease outbreak highlighted the need to build national and worldwide capacity to provide care for patients with highly infectious diseases. Specialized biocontainment units were successful in treating several critically ill patients with Ebola virus disease both in the United States and Europe. Several key principles underlie the care of critically ill patients in a high-containment environment. Environmental factors, staffing, equipment, training, laboratory testing, procedures, and waste management each present unique challenges. A multidisciplinary approach is key to developing effective systems and protocols to maintain the safety of patients, staff, and communities.
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Affiliation(s)
- Brian T Garibaldi
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, 1830 East Monument Street, 5th Floor, Baltimore, MD 21205, USA
| | - Daniel S Chertow
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, 10 Center Drive, Room 2C-145, Bethesda, MD 20892-1662, USA.
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15
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Bossaert L, Perkins G, Askitopoulou H, Raffay V, Greif R, Haywood K, Mentzelopoulos S, Nolan J, Van de Voorde P, Xanthos T. Ethik der Reanimation und Entscheidungen am Lebensende. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0329-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Perkins G, Handley A, Koster R, Castrén M, Smyth M, Olasveengen T, Monsieurs K, Raffay V, Gräsner JT, Wenzel V, Ristagno G, Soar J. [Adult basic life support and automated external defibrillation.]. Notf Rett Med 2017; 20:3-24. [PMID: 32214897 PMCID: PMC7087749 DOI: 10.1007/s10049-017-0328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- G.D. Perkins
- Warwick Medical School, University of Warwick, Coventry, UK
- Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | | | - R.W. Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, Niederlande
| | - M. Castrén
- Department of Emergency Medicine and Services, Helsinki University Hospital and Helsinki University, Helsinki, Finnland
| | - M.A. Smyth
- Warwick Medical School, University of Warwick, Coventry, UK
- West Midlands Ambulance Service NHS Foundation Trust, Dudley, UK
| | - T. Olasveengen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine and Department of Anesthesiology, Oslo University Hospital, Oslo, Norwegen
| | - K.G. Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgien
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgien
| | - V. Raffay
- Municipal Institute for Emergency Medicine Novi Sad, Novi Sad, Serbien
| | - J.-T. Gräsner
- Department of Anaesthesia and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Kiel, Deutschland
| | - V. Wenzel
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Österreich
| | - G. Ristagno
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche „Mario Negri“, Milan, Italien
| | - J. Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
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Social Resilience and Critical Infrastructure Systems. NATO SCIENCE FOR PEACE AND SECURITY SERIES C: ENVIRONMENTAL SECURITY 2017. [PMCID: PMC7122633 DOI: 10.1007/978-94-024-1123-2_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Resilience analysis and thinking serve as emerging conceptual frameworks relevant for applications assessing risk. Connections between the domains of resilience and risk assessment include vulnerability. Infrastructure, social, economic, and ecological systems (and combined social-ecological systems) are vulnerable to exogenous global change, and other disturbances, both natural and anthropologically derived. Resilience analysis fundamentally seeks to provide the groundwork for a ‘soft landing’, or an efficient and robust restoration following disturbance as well as the ability to reduce harms while helping the targeted system rebound to full functionality as quickly and efficiently where possible. Such applications are consistent with The National Academy of Sciences (NAS) definition of resilience, which more broadly denotes the field as “the ability to plan and prepare for, absorb, recover from, and adapt to adverse events” (Larkin S, Fox-Lent C, Eisenberg DA, Trump BD, Wallace S, Chadderton C, Linkov I (2015) Benchmarking agency and organizational practices in resilience decision making. Environ Sys Decisions 35(2):185–195). Given this definition, we seek to describe how resilience analysis and resilience thinking might be applied to social considerations for critical infrastructure systems. Specifically, we indicate how resilience might better coordinate societal elements of such infrastructure to identify, mitigate, and efficiently recover from systemic shocks and stresses that threaten system performance and service capacity.
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18
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Leligdowicz A, Fischer WA, Uyeki TM, Fletcher TE, Adhikari NKJ, Portella G, Lamontagne F, Clement C, Jacob ST, Rubinson L, Vanderschuren A, Hajek J, Murthy S, Ferri M, Crozier I, Ibrahima E, Lamah MC, Schieffelin JS, Brett-Major D, Bausch DG, Shindo N, Chan AK, O'Dempsey T, Mishra S, Jacobs M, Dickson S, Lyon GM, Fowler RA. Ebola virus disease and critical illness. Crit Care 2016; 20:217. [PMID: 27468829 PMCID: PMC4965892 DOI: 10.1186/s13054-016-1325-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/26/2016] [Indexed: 12/26/2022] Open
Abstract
As of 20 May 2016 there have been 28,646 cases and 11,323 deaths resulting from the West African Ebola virus disease (EVD) outbreak reported to the World Health Organization. There continue to be sporadic flare-ups of EVD cases in West Africa.EVD presentation is nonspecific and characterized initially by onset of fatigue, myalgias, arthralgias, headache, and fever; this is followed several days later by anorexia, nausea, vomiting, diarrhea, and abdominal pain. Anorexia and gastrointestinal losses lead to dehydration, electrolyte abnormalities, and metabolic acidosis, and, in some patients, acute kidney injury. Hypoxia and ventilation failure occurs most often with severe illness and may be exacerbated by substantial fluid requirements for intravascular volume repletion and some degree of systemic capillary leak. Although minor bleeding manifestations are common, hypovolemic and septic shock complicated by multisystem organ dysfunction appear the most frequent causes of death.Males and females have been equally affected, with children (0-14 years of age) accounting for 19 %, young adults (15-44 years) 58 %, and older adults (≥45 years) 23 % of reported cases. While the current case fatality proportion in West Africa is approximately 40 %, it has varied substantially over time (highest near the outbreak onset) according to available resources (40-90 % mortality in West Africa compared to under 20 % in Western Europe and the USA), by age (near universal among neonates and high among older adults), and by Ebola viral load at admission.While there is no Ebola virus-specific therapy proven to be effective in clinical trials, mortality has been dramatically lower among EVD patients managed with supportive intensive care in highly resourced settings, allowing for the avoidance of hypovolemia, correction of electrolyte and metabolic abnormalities, and the provision of oxygen, ventilation, vasopressors, and dialysis when indicated. This experience emphasizes that, in addition to evaluating specific medical treatments, improving the global capacity to provide supportive critical care to patients with EVD may be the greatest opportunity to improve patient outcomes.
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Affiliation(s)
| | - William A Fischer
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Timothy M Uyeki
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thomas E Fletcher
- Defence Medical Services, Whittington Barracks, Lichfield, UK
- Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK
| | - Neill K J Adhikari
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Francois Lamontagne
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Shevin T Jacob
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Lewis Rubinson
- Department of Medicine, University of Maryland, Baltimore, MD, USA
| | - Abel Vanderschuren
- Centre de recherche de l'institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada
| | - Jan Hajek
- Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada
| | - Srinivas Murthy
- Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada
| | | | - Ian Crozier
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elhadj Ibrahima
- Department of Infectious and Parasitic Diseases, Donka Hospital, Conakry, Guinea
| | - Marie-Claire Lamah
- Department of Infectious and Parasitic Diseases, Donka Hospital, Conakry, Guinea
| | - John S Schieffelin
- Department of Pediatrics, School of Medicine and School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - David Brett-Major
- Department of Preventive Medicine and Biometrics, Uniformed Services University, Bethesda, MD, USA
| | - Daniel G Bausch
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - Nikki Shindo
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - Adrienne K Chan
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tim O'Dempsey
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Michael Jacobs
- Department of Infection, Royal Free London NHS Foundation Trust, London, UK
| | - Stuart Dickson
- Acute Medicine and Intensive Care, Derriford Hospital, Plymouth, UK
| | - G Marshall Lyon
- Department of Infectious Diseases, Emory University Hospital, Atlanta, Georgia, USA
| | - Robert A Fowler
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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de la Calle-Prieto F, Arsuaga-Vicente M, Mora-Rillo M, Arnalich-Fernandez F, Arribas JR. [Ebola virus disease: Update]. Enferm Infecc Microbiol Clin 2016; 34:452-60. [PMID: 26774254 DOI: 10.1016/j.eimc.2015.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/21/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
The first known Ebola outbreak occurred in 1976. Since then, 24 limited outbreaks had been reported in Central Africa, but never affecting more than 425 persons. The current outbreak in Western Africa is the largest in history with 28,220 reported cases and 11,291 deaths. The magnitude of the epidemic has caused worldwide alarm. For the first time, evacuated patients were treated outside Africa, and secondary cases have occurred in Spain and the United States. Since the start of the current epidemic, our knowledge about the epidemiology, clinical picture, laboratory findings, and virology of Ebola virus disease has considerably expanded. For the first time, experimental treatment has been tried, and there have been spectacular advances in vaccine development. A review is presented of these advances in the knowledge of Ebola virus disease.
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Affiliation(s)
- Fernando de la Calle-Prieto
- Unidad de Medicina Tropical y del Viajero, Servicio de Medicina Interna, Hospital La Paz-Cantoblanco-Carlos III, IdiPAZ, Madrid, España
| | - Marta Arsuaga-Vicente
- Unidad de Medicina Tropical y del Viajero, Servicio de Medicina Interna, Hospital La Paz-Cantoblanco-Carlos III, IdiPAZ, Madrid, España
| | - Marta Mora-Rillo
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Servicio de Medicina Interna, Hospital La Paz-Cantoblanco-Carlos III, IdiPAZ, Madrid, España
| | | | - Jose Ramon Arribas
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Servicio de Medicina Interna, Hospital La Paz-Cantoblanco-Carlos III, IdiPAZ, Madrid, España.
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20
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Caring for Critically Ill Ebola Virus Disease Patients With One Hand Tied Behind Your Back. Crit Care Med 2015; 43:2249-50. [PMID: 26376249 DOI: 10.1097/ccm.0000000000001221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Monsieurs K, Nolan J, Bossaert L, Greif R, Maconochie I, Nikolaou N, Perkins G, Soar J, Truhlář A, Wyllie J, Zideman D. Kurzdarstellung. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0097-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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22
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Ethik der Reanimation und Entscheidungen am Lebensende. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0083-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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23
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Perkins G, Handley A, Koster R, Castrén M, Smyth M, Olasveengen T, Monsieurs K, Raffay V, Gräsner JT, Wenzel V, Ristagno G, Soar J. [Adult basic life support and automated external defibrillation.]. Notf Rett Med 2015; 18:748-769. [PMID: 32214896 PMCID: PMC7088113 DOI: 10.1007/s10049-015-0081-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- G.D. Perkins
- Warwick Medical School, University of Warwick, Coventry, UK
- Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | | | - R.W. Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, Niederlande
| | - M. Castrén
- Department of Emergency Medicine and Services, Helsinki University Hospital and Helsinki University, Helsinki, Finnland
| | - M.A. Smyth
- Warwick Medical School, University of Warwick, Coventry, UK
- West Midlands Ambulance Service NHS Foundation Trust, Dudley, UK
| | - T. Olasveengen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine and Department of Anesthesiology, Oslo University Hospital, Oslo, Norwegen
| | - K.G. Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgien
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgien
| | - V. Raffay
- Municipal Institute for Emergency Medicine Novi Sad, Novi Sad, Serbien
| | - J.-T. Gräsner
- Department of Anaesthesia and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Kiel, Deutschland
| | - V. Wenzel
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Österreich
| | - G. Ristagno
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche „Mario Negri“, Milan, Italien
| | - J. Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
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Torabi-Parizi P, Davey RT, Suffredini AF, Chertow DS. Response. Chest 2015; 148:e65. [PMID: 26238847 DOI: 10.1378/chest.15-0986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Parizad Torabi-Parizi
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD.
| | - Richard T Davey
- Clinical Research Section, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Anthony F Suffredini
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Daniel S Chertow
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD
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Bordes J, Gagnon N, Cotte J, Greslan TD, Rousseaul C, Billhot M, Cournac JM, Karkowski L, Moroge S, Duron S, Quentin B, Cellarier G. Caring for Critically Ill Patients Infected With the Ebola Virus: Logistic and Human Challenges. Chest 2015; 148:e64-e65. [PMID: 26238846 DOI: 10.1378/chest.15-0818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Julien Bordes
- French Military Ebola Virus Disease Treatment Centre, Toulon, France; Sainte Anne Military Teaching Hospital, Toulon, France.
| | - Nicolas Gagnon
- French Military Ebola Virus Disease Treatment Centre, Toulon, France; Legouest Military Teaching Hospital, Metz, France
| | - Jean Cotte
- French Military Ebola Virus Disease Treatment Centre, Toulon, France; Sainte Anne Military Teaching Hospital, Toulon, France
| | - Thierry de Greslan
- French Military Ebola Virus Disease Treatment Centre, Toulon, France; Val De Grâce Military Teaching Hospital, Paris, France
| | | | - Magali Billhot
- French Military Ebola Virus Disease Treatment Centre, Toulon, France; Val De Grâce Military Teaching Hospital, Paris, France
| | - Jean Marie Cournac
- Percy Military Teaching Hospital, Paris, France; French Military Ebola Virus Disease Treatment Centre, Toulon, France
| | - Ludovic Karkowski
- French Military Ebola Virus Disease Treatment Centre, Toulon, France; Legouest Military Teaching Hospital, Metz, France
| | - Sophie Moroge
- Laveran Military Teaching Hospital, Marseille, France
| | - Sandrine Duron
- French Military Ebola Virus Disease Treatment Centre, Toulon, France; French Military Health Service Headquarter, Paris, France
| | - Benoit Quentin
- French Military Ebola Virus Disease Treatment Centre, Toulon, France; French Military Health Service Headquarter, Paris, France
| | - Gilles Cellarier
- French Military Ebola Virus Disease Treatment Centre, Toulon, France; Sainte Anne Military Teaching Hospital, Toulon, France
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26
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European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation. Resuscitation 2015; 95:81-99. [PMID: 26477420 DOI: 10.1016/j.resuscitation.2015.07.015] [Citation(s) in RCA: 722] [Impact Index Per Article: 80.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, Perkins GD, Soar J, Truhlář A, Wyllie J, Zideman DA, Alfonzo A, Arntz HR, Askitopoulou H, Bellou A, Beygui F, Biarent D, Bingham R, Bierens JJ, Böttiger BW, Bossaert LL, Brattebø G, Brugger H, Bruinenberg J, Cariou A, Carli P, Cassan P, Castrén M, Chalkias AF, Conaghan P, Deakin CD, De Buck ED, Dunning J, De Vries W, Evans TR, Eich C, Gräsner JT, Greif R, Hafner CM, Handley AJ, Haywood KL, Hunyadi-Antičević S, Koster RW, Lippert A, Lockey DJ, Lockey AS, López-Herce J, Lott C, Maconochie IK, Mentzelopoulos SD, Meyran D, Monsieurs KG, Nikolaou NI, Nolan JP, Olasveengen T, Paal P, Pellis T, Perkins GD, Rajka T, Raffay VI, Ristagno G, Rodríguez-Núñez A, Roehr CC, Rüdiger M, Sandroni C, Schunder-Tatzber S, Singletary EM, Skrifvars MB, Smith GB, Smyth MA, Soar J, Thies KC, Trevisanuto D, Truhlář A, Vandekerckhove PG, de Voorde PV, Sunde K, Urlesberger B, Wenzel V, Wyllie J, Xanthos TT, Zideman DA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation 2015; 95:1-80. [PMID: 26477410 DOI: 10.1016/j.resuscitation.2015.07.038] [Citation(s) in RCA: 568] [Impact Index Per Article: 63.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Koenraad G Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, University Hospital Bern, Bern, Switzerland; University of Bern, Bern, Switzerland
| | - Ian K Maconochie
- Paediatric Emergency Medicine Department, Imperial College Healthcare NHS Trust and BRC Imperial NIHR, Imperial College, London, UK
| | | | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jonathan Wyllie
- Department of Neonatology, The James Cook University Hospital, Middlesbrough, UK
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Bossaert LL, Perkins GD, Askitopoulou H, Raffay VI, Greif R, Haywood KL, Mentzelopoulos SD, Nolan JP, Van de Voorde P, Xanthos TT, Georgiou M, Lippert FK, Steen PA. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95:302-11. [DOI: 10.1016/j.resuscitation.2015.07.033] [Citation(s) in RCA: 256] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Heller JA, DeMaria S, Levine A, Heller BJ, Augoustides JG, Stone M, Silvay G, Goldberg A. Cardiovascular and Pulmonary Impact of the Ebola Virus: A Review of Current Literature and Practices. J Cardiothorac Vasc Anesth 2015; 29:1672-6. [PMID: 26706795 DOI: 10.1053/j.jvca.2015.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Joshua A Heller
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Samuel DeMaria
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Adam Levine
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Benjamin J Heller
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Marc Stone
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - George Silvay
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andrew Goldberg
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY
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Clinical characteristics of 154 patients suspected of having Ebola virus disease in the Ebola holding center of Jui Government Hospital in Sierra Leone during the 2014 Ebola outbreak. Eur J Clin Microbiol Infect Dis 2015. [PMID: 26223324 DOI: 10.1007/s10096-015-2457-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article sought to analyze the clinical features of 154 patients suspected of having Ebola virus disease (EVD) in an Ebola holding center in Sierra Leone from October 1 through November 9, 2014. We found that 108 of the 154 patients were confirmed with EVD. Eighty-five had known outcomes. Forty-nine of the 85 patients had been exposed to EVD. The average mortality rate was 60%. The mean interval between the onset of symptoms and hospitalization was 5.8 ± 3.3 days. The mean incubation period was 9.2 ± 6.7 days. Common symptoms of the EVD patients on admission were fatigue (85.2%), anorexia (84.3%), fever (75.9%), and headache (72.2%). Our data showed that the total symptoms of confirmed EVD patients were significantly higher than those of non-EVD patients (9 vs. 5.5; p < 0.001). The likelihood of EVD was 87.6% when a patient presented more than 6 out of 21 symptoms on admission. The survivors were significantly younger than non-survivors (24.0 ± 10.0 years vs. 31.3 ± 15.3 years; p = 0.016). The real-time polymerase chain reaction (PCR) analysis showed that, in the survivors, the virus load was significantly lower (Ct value: 25.2 ± 4.1 vs. 28.7 ± 5.7; p = 0.002). Multivariate analysis showed that age, fever, and viral load were independent predictors of mortality. Taken together, our data suggested that a cutoff of six symptoms could be used to predict patients with high or low risk of EVD. It seemed that age, fever, and viral load were the main risk factors associated with EVD mortality.
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Abstract
Infectious disease events were in the headlines in 2014. West Africa experienced the worst Ebola virus disease (EVD) outbreak ever recorded. The world was stunned when the deadly virus began to spread to other countries. The health care system in the United States responded by designating specialized centers to care for patients with EVD. All health care workers must understand the isolation processes involved in caring for these patients. Using personal protective equipment is imperative and requires adjustments in how care is provided. Staffing patterns must be altered to provide safe care, while maintaining safety of health care workers. This article provides perspectives of the critical care nurse manager and bedside nurse who participated in the development of the care processes for patients with EVD at the National Institutes of Health to help health care colleagues better understand issues experienced and to help prepare them if they encounter patients with EVD.
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Affiliation(s)
- Susan S. Johnson
- Susan S. Johnson is Nurse Manager, Department of Nursing, National Institutes of Health, 10 Center Dr, Bldg 10-CRC 3SWS-ICU, Bethesda, MD 20892 . Neil Barranta is Clinical Nurse Manager, Department of Nursing, National Institutes of Health, Bethesda, Maryland. Dan Chertow is Assistant Clinical Investigator, Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland
| | - Neil Barranta
- Susan S. Johnson is Nurse Manager, Department of Nursing, National Institutes of Health, 10 Center Dr, Bldg 10-CRC 3SWS-ICU, Bethesda, MD 20892 . Neil Barranta is Clinical Nurse Manager, Department of Nursing, National Institutes of Health, Bethesda, Maryland. Dan Chertow is Assistant Clinical Investigator, Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland
| | - Dan Chertow
- Susan S. Johnson is Nurse Manager, Department of Nursing, National Institutes of Health, 10 Center Dr, Bldg 10-CRC 3SWS-ICU, Bethesda, MD 20892 . Neil Barranta is Clinical Nurse Manager, Department of Nursing, National Institutes of Health, Bethesda, Maryland. Dan Chertow is Assistant Clinical Investigator, Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland
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Kadri SS, Rhee C, Fortna GS, O'Grady NP. Critical Care Medicine and Infectious Diseases: An Emerging Combined Subspecialty in the United States. Clin Infect Dis 2015; 61:609-14. [PMID: 25944345 DOI: 10.1093/cid/civ360] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/24/2015] [Indexed: 12/16/2022] Open
Abstract
The recent rise in unfilled training positions among infectious diseases (ID) fellowship programs nationwide indicates that ID is declining as a career choice among internal medicine residency graduates. Supplementing ID training with training in critical care medicine (CCM) might be a way to regenerate interest in the specialty. Hands-on patient care and higher salaries are obvious attractions. High infection prevalence and antibiotic resistance in intensive care units, expanding immunosuppressed host populations, and public health crises such as the recent Ebola outbreak underscore the potential synergy of CCM-ID training. Most intensivists receive training in pulmonary medicine and only 1% of current board-certified intensivists are trained in ID. While still small, this cohort of CCM-ID certified physicians has continued to rise over the last 2 decades. ID and CCM program leadership nationwide must recognize these trends and the merits of the CCM-ID combination to facilitate creation of formal dual-training opportunities.
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Affiliation(s)
- Sameer S Kadri
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Naomi P O'Grady
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
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