Remote-Controlled and Pulse Pressure–Guided Fluid Treatment for Adult Patients with Viral Hemorrhagic Fevers

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  • 1 Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;
  • 2 Department of Intensive Care, Amsterdam University Medical Centres, Amsterdam, The Netherlands;
  • 3 Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom;
  • 4 Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila, Philippines;
  • 5 Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;
  • 6 School of Population Health and Environmental Sciences, King’s College London and Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom;
  • 7 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada;
  • 8 Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam;
  • 9 Institute for Medical Microbiology, Martin Luther University, Halle-Wittenberg, Germany;
  • 10 United Kingdom Public Health Rapid Support Team, London, United Kingdom;
  • 11 ISARIC Global Support Centre, International Severe Acute Respiratory and Emerging Infection Consortium, Oxford, United Kingdom

Circulatory shock, caused by severe intravascular volume depletion resulting from gastrointestinal losses and profound capillary leak, is a common clinical feature of viral hemorrhagic fevers, including Ebola virus disease, Marburg hemorrhagic fever, and Lassa fever. These conditions are associated with high case fatality rates, and they carry a significant risk of infection for treating personnel. Optimized fluid therapy is the cornerstone of management of these diseases, but there are few data on the extent of fluid losses and the severity of the capillary leak in patients with VHFs, and no specific guidelines for fluid resuscitation and hemodynamic monitoring exist. We propose an innovative approach for monitoring VHF patients, in particular suited for low-resource settings, facilitating optimizing fluid therapy through remote-controlled and pulse pressure–guided fluid resuscitation. This strategy would increase the capacity for adequate supportive care, while decreasing the risk for virus transmission to health personnel.

Author Notes

Address correspondence to Arjen M. Dondorp, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok 10400, Thailand. E-mail: arjen@tropmedres.ac

Authors’ addresses: Marcus J. Schultz and Arjen M. Dondorp, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, Department of Intensive Care, Amsterdam University Medical Centres, Amsterdam, The Netherlands, and Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom, E-mails: marcus.j.schultz@gmail.com and arjen@tropmedres.ac. Jacqueline Deen, Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila, Philippines, E-mail: deen.jacqueline@gmail.com. Lorenz von Seidlein, Nicholas P. J. Day, Ben Cooper, and Nicholas J. White, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, and Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom, E-mails: lorenz@tropmedres.ac, nickd@tropmedres.ac, ben@tropmedres.ac, and nickw@tropmedres.ac. Chaisith Sivakorn, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, E-mail: chaisith.siv@mahidol.edu. Alex Kumar, School of Population Health and Environmental Sciences, King’s College London and Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom, E-mail: dralexanderkumar@gmail.com. Neill K. J. Adhikari, Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada, E-mail: neill.adhikari@sunnybrook.ca. Bridget Wills, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom, and Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam, E-mail: bwills@oucru.org. Alexander S. Kekulé, Institute for Medical Microbiology, Martin Luther University, Halle-Wittenberg, Germany, E-mail: office@kekule.de. Alex P. Salam, United Kingdom Public Health Rapid Support Team, London, United Kingdom, and Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom, E-mail: alex.salam@ndm.ox.ac.uk. Peter Horby and Piero Olliaro, ISARIC Global Support Centre, International Severe Acute Respiratory and emerging Infection Consortium, Oxford, United Kingdom, and Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom, E-mails: peter.horby@ndm.ox.ac.uk and piero.olliaro@ndm.ox.ac.uk.

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