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Parizad Torabi-Parizi, MD; Richard T. Davey, Jr, MD; Anthony F. Suffredini, MD; Daniel S. Chertow, MD
Author and Funding Information

From the Critical Care Medicine Department (Drs Torabi-Parizi, Suffredini, and Chertow), Clinical Center, National Institutes of Health; and the Clinical Research Section (Dr Davey), Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health.

CORRESPONDENCE TO: Parizad Torabi-Parizi, MD, Critical Care Medicine Department, National Institutes of Health, 10 Center Dr, 2C145, Bethesda, MD 20892; e-mail: torabiparizip@cc.nih.gov


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):e65. doi:10.1378/chest.15-0986
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To the Editor:

In their letter, Dr Bordes and colleagues highlight some of the challenges of providing care for seriously ill patients with Ebola virus disease (EVD) in a resource-limited setting. They describe an Ebola treatment unit in West Africa with capacity to provide higher levels of care, yet emphasize challenges associated with environmental conditions and excessive staffing needs. Because of the need for extensive personal protective equipment use in an environment with high ambient temperature and humidity, and in the absence of a facility with adequate climate control, compromises must be made to balance the care of patients with the safety of health-care workers. The authors rightly question the feasibility of providing a continual presence of competent staffing for critically ill patients under such conditions.

In the high-level containment units in the European Union and United States, where climate factors are less restrictive, robust staffing needs remain a significant although not insurmountable challenge. Other challenges in the provision of critical care to patients with EVD include lack of availability of specialized imaging studies, including CT scan and MRI, and limited access to microbiologic or other specialized non-point-of-care laboratory testing. We agree, based on our own experience as well as that described by others in US and European Union centers, that caring for patients with EVD presents multiple logistic and human challenges.1 The decision to provide continuous intensivist coverage for critically ill patients with EVD must be addressed in the context of available resources, human and otherwise, at any given facility. The geographic location and environmental conditions in a treatment facility are among the many factors that must be taken into account when deciding what level of care is feasible and safe. Lessons learned from this epidemic should guide ongoing activities for present and future outbreaks to maximize the level of quality care delivered to patients with EVD.

Acknowledgments

Other contributions: The opinions expressed herein represent those of the authors and do not reflect official views or policies endorsed by the US Department of Health and Human Services.

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]
 

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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]
 
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