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Correspondence |

Caring for Critically Ill Patients Infected With the Ebola VirusCaring for Patients With Ebola: Logistic and Human Challenges FREE TO VIEW

Julien Bordes, MD; Nicolas Gagnon, MD; Jean Cotte, MD; Thierry de Greslan, MD; Claire Rousseaul, MD; Magali Billhot, MD; Jean Marie Cournac, MD; Ludovic Karkowski, MD; Sophie Moroge, MD; Sandrine Duron, MD; Benoit Quentin, MD; Gilles Cellarier, MD
Author and Funding Information

From the French Military Ebola Virus Disease Treatment Centre (Drs Bordes, Gagnon, Cotte, de Greslan, Rosseaul, Billhot, Cournac, Karkowski, Moroge, Duron, Quentin, and Cellarier); Sainte Anne Military Teaching Hospital (Drs Bordes, Cotte, and Cellarier), Toulon, France; Legouest Military Teaching Hospital (Drs Gagnon and Karkowski), Metz, France; Val De Grâce Military Teaching Hospital (Drs de Greslan and Billhot), Paris, France; Clermont Tonnerre Military Teaching Hospital (Dr Rosseaul), Brest, France; Percy Military Teaching Hospital (Dr Cournac), Paris, France; Laveran Military Teaching Hospital (Dr Moroge), Marseille, France; and French Military Health Service Headquarter (Drs Duron and Quentin), Paris, France.

CORRESPONDENCE TO: Julien Bordes, MD, Intensive Care Department, Sainte Anne Military Teaching Hospital, Blvd Sainte Anne, 83000 Toulon, France; e-mail: guiluxe.cts.cky@gmail.com


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(2):e64-e65. doi:10.1378/chest.15-0818
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To the Editor:

We read with great interest the article by Torabi-Parizi et al1 in CHEST (June 2015) that gives valuable perspectives on the ethical and practical considerations in providing critical care to patients infected with the Ebola virus. As part of France’s contribution to the international response to the Ebola outbreak, a 10-bed military Ebola virus disease treatment unit has been deployed since January 2015 in Conakry, Guinea, where the epidemic remains active. The unit comprises a multidisciplinary team of senior physicians combined with nurses, laboratory technicians, pharmacists, and administrative and command elements. Our medical team is composed of two intensivists, four internists, one neurologist, one cardiologist, one psychiatrist, two biologists, and one epidemiologist. The structure has been designed and equipped as an ICU, with permanent video monitoring of the Ebola patient room and capacity for central venous access, urinary catheter, mechanical ventilation, and vasopressors administration in the “red zone,” which is the Ebola patients’ hospitalization unit. However, no hemodialysis is available.

We do agree with the authors that the main factor that might improve the care provided to critically ill patients with Ebola is the permanent presence of competent personnel in the “red zone.” However, we have to keep in mind that the ability to spend time in protective personal equipment in the red zone is limited, especially in epidemic zones, because of the high temperature and moisture (Fig 1). Some teams deployed in Sierra Leone reported that 40 min was the maximal time that personnel could spend in protective personal equipment.2 In our experience, and in the local Guinean climatic conditions, it is not bearable to spend > 60 min. And it is physically testing for nonacclimatized personnel to enter the red zone several times in 1 day. To limit the risk of contamination, at least two people have to be in the red zone: Each person is responsible for his or her colleague. As a consequence, a permanent presence in the red zone would require a great number of health-care workers, 48 per day if we consider the need for two workers each hour. This staff need is not compatible with the means of a deployed unit such as ours. We also think that this goal is difficult to reach in a developed country, especially if several patients infected with Ebola are hospitalized at the same time. Finally, staff resources are the main limiting factor to improving critical care for patients with Ebola.

Figure Jump LinkFigure 1 –  A, Medical team in personal protective equipment admitting a patient in the French Military Ebola Virus Disease Treatment Center. B, French health-care workers (a physician and a nurse) after having removed the personal protective equipment.Grahic Jump Location

References

Torabi-Parizi P, Davey RT Jr, Suffredini AF, Chertow DS. Ethical and practical considerations in providing critical care to patients with Ebola virus disease. Chest. 2015;147(6):1460-1466. [CrossRef] [PubMed]
 
Wolz A. Face to face with Ebola—an emergency care center in Sierra Leone. N Engl J Med. 2014;371(12):1081-1083. [CrossRef] [PubMed]
 

Figures

Figure Jump LinkFigure 1 –  A, Medical team in personal protective equipment admitting a patient in the French Military Ebola Virus Disease Treatment Center. B, French health-care workers (a physician and a nurse) after having removed the personal protective equipment.Grahic Jump Location

Tables

References

Torabi-Parizi P, Davey RT Jr, Suffredini AF, Chertow DS. Ethical and practical considerations in providing critical care to patients with Ebola virus disease. Chest. 2015;147(6):1460-1466. [CrossRef] [PubMed]
 
Wolz A. Face to face with Ebola—an emergency care center in Sierra Leone. N Engl J Med. 2014;371(12):1081-1083. [CrossRef] [PubMed]
 
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