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

ABSTRACTCirculatory 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.

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Use of the Syrian Hamster as a New Model of Ebola Virus Disease and Other Viral Hemorrhagic Fevers

Viruses ◽

10.3390/v4123754 ◽

2012 ◽

Vol 4 (12) ◽

pp. 3754-3784 ◽

Cited By ~ 39

Author(s):

Victoria Wahl-Jensen ◽

Laura Bollinger ◽

David Safronetz ◽

Fabian de Kok-Mercado ◽

Dana Scott ◽

...

Keyword(s):

Syrian Hamster ◽

Ebola Virus ◽

Virus Disease ◽

Ebola Virus Disease ◽

New Model ◽

Hemorrhagic Fevers ◽

Viral Hemorrhagic Fevers

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Evidence-Based Clinical Management of Ebola Virus Disease and Epidemic Viral Hemorrhagic Fevers

Infectious Disease Clinics of North America ◽

10.1016/j.idc.2018.10.013 ◽

2019 ◽

Vol 33 (1) ◽

pp. 247-264 ◽

Cited By ~ 3

Author(s):

Christophe Clément ◽

Neill K.J. Adhikari ◽

François Lamontagne

Keyword(s):

Clinical Management ◽

Ebola Virus ◽

Virus Disease ◽

Ebola Virus Disease ◽

Evidence Based ◽

Hemorrhagic Fevers ◽

Viral Hemorrhagic Fevers

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A Methodology for Determining Which Diseases Warrant Care in a High-Level Containment Care Unit

Viruses ◽

10.3390/v11090773 ◽

2019 ◽

Vol 11 (9) ◽

pp. 773 ◽

Cited By ~ 1

Author(s):

Theodore J. Cieslak ◽

Jocelyn J. Herstein ◽

Mark G. Kortepeter ◽

Angela L. Hewlett

Keyword(s):

Western Europe ◽

Ebola Virus ◽

Virus Disease ◽

The United States ◽

Reproductive Number ◽

Traditional Management ◽

Infectious Dose ◽

Hemorrhagic Fevers ◽

Viral Hemorrhagic Fevers ◽

High Level

Although the concept of high-level containment care (HLCC or ‘biocontainment’), dates back to 1969, the 2014–2016 outbreak of Ebola virus disease (EVD) brought with it a renewed emphasis on the use of specialized HLCC units in the care of patients with EVD. Employment of these units in the United States and Western Europe resulted in a significant decrease in mortality compared to traditional management in field settings. Moreover, this employment appeared to significantly lessen the risk of nosocomial transmission of disease; no secondary cases occurred among healthcare workers in these units. While many now accept the wisdom of utilizing HLCC units and principles in the management of EVD (and, presumably, of other transmissible and highly hazardous viral hemorrhagic fevers, such as those caused by Marburg and Lassa viruses), no consensus exists regarding additional diseases that might warrant HLCC. We propose here a construct designed to make such determinations for existing and newly discovered diseases. The construct examines infectivity (as measured by the infectious dose needed to infect 50% of a given population (ID50)), communicability (as measured by the reproductive number (R0)), and hazard (as measured by morbidity and mortality). Diseases fulfilling all three criteria (i.e., those that are highly infectious, communicable, and highly hazardous) are considered candidates for HLCC management if they also meet a fourth criterion, namely that they lack effective and available licensed countermeasures.

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A Note on Estimating the Case Fatality Ratio for Novel Corona Virus Disease (Covid-19)

Coronaviruses ◽

10.2174/2666796701999200721003524 ◽

2020 ◽

Vol 01 ◽

Author(s):

Prafulla Kumar Swain

Keyword(s):

Confidence Interval ◽

Graphical Representation ◽

Virus Disease ◽

Case Fatality ◽

Case Fatality Ratio ◽

Healthcare Planning ◽

Robust Estimates ◽

University Of Oxford ◽

Pros And Cons ◽

Death Cases

Background: In this paper an attempt has been made to estimate the Case Fatality Ratio (CFR) for coronavirus disease of India and few selected countries. and Also, highlighted the pros and cons of obtaining crude and adjusted CFR of COVID-19 pandemic. Material and Methods: Data extracted from WHO situation report and University of Oxford website have been used for this analysis. The CFR and its 95% confidence interval were computed, trend and bar plot was used for graphical representation. Results: The worldwide crude CFR stands 6.73% (95% CI 6.69 to 6.76) based on 21, 83, 877 confirmed and 1,46,872 death cases(as on 17th April,2020). Belgium was highest CFR 13.95% as compared to others. However, India’s CFR was found to be around 3.26% (as on 17th April, 2020). Conclusion: In conclusion, the estimation and interpretation of CFR is critical in response to ongoing COVID-19. The initial CFR estimates are subject to change, still it is useful for healthcare planning over the coming months. Moreover, the precise and robust estimates of CFR will be available only at the end of the epidemic.

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JOINT ESTIMATION OF THE TRANSMISSIBILITY AND SEVERITY OF EBOLA VIRUS DISEASE IN REAL TIME

Journal of Biological System ◽

10.1142/s0218339017400022 ◽

2017 ◽

Vol 25 (04) ◽

pp. 587-603 ◽

Cited By ~ 2

Author(s):

YUSUKE ASAI ◽

HIROSHI NISHIURA

Keyword(s):

Real Time ◽

Ebola Virus ◽

Virus Disease ◽

Critical Role ◽

Estimation Method ◽

Case Fatality ◽

Ascertainment Bias ◽

Joint Estimation ◽

Ebola Virus Disease ◽

Strong Impact

The effective reproduction number [Formula: see text], the average number of secondary cases that are generated by a single primary case at calendar time [Formula: see text], plays a critical role in interpreting the temporal transmission dynamics of an infectious disease epidemic, while the case fatality risk (CFR) is an indispensable measure of the severity of disease. In many instances, [Formula: see text] is estimated using the reported number of cases (i.e., the incidence data), but such report often does not arrive on time, and moreover, the rate of diagnosis could change as a function of time, especially if we handle diseases that involve substantial number of asymptomatic and mild infections and large outbreaks that go beyond the local capacity of reporting. In addition, CFR is well known to be prone to ascertainment bias, often erroneously overestimated. In this paper, we propose a joint estimation method of [Formula: see text] and CFR of Ebola virus disease (EVD), analyzing the early epidemic data of EVD from March to October 2014 and addressing the ascertainment bias in real time. To assess the reliability of the proposed method, coverage probabilities were computed. When ascertainment effort plays a role in interpreting the epidemiological dynamics, it is useful to analyze not only reported (confirmed or suspected) cases, but also the temporal distribution of deceased individuals to avoid any strong impact of time dependent changes in diagnosis and reporting.

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111 Burn Sepsis Screening Tool to Facilitate Diagnosis of Burn Sepsis

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.115 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S74-S75

Author(s):

Kaitlyn Libraro ◽

Palmer Bessey ◽

Jamie Heffernan ◽

James Gallagher

Keyword(s):

Critically Ill ◽

Screening Tool ◽

Burn Injury ◽

Clinical Signs ◽

Case Fatality ◽

Inhalation Injury ◽

Clinical Feature ◽

Sepsis Diagnosis ◽

Acute Decompensation ◽

Sepsis Screening

Abstract Introduction Sepsis following critical burn injury is an ominous development that can lead to death. Most patients will manifest a systemic inflammatory response syndrome (SIRS), even without being septic. This may obscure the clinical recognition of developing sepsis and delay the initiation of effective treatment. We developed a burn sepsis screening tool (BSST) to facilitate the recognition of developing burn sepsis. The purpose of this study was to review the utility of that tool. Methods The BSST was based on several clinical signs, laboratory values, and changes in physiologic support modalities associated with sepsis. It consisted of nine parameters that could be scored as indicating or not indicating sepsis or not applicable. If three were positive, the patient was identified as septic, and a search for a septic source was undertaken and treatment initiated. The BSST was completed on patients judged to be critically ill during morning rounds over a period of nine months. The values were transcribed into a secure web database and analyzed using SAS 9.4. Results There were 593 individual encounters on 31 critically ill patients with burns and/or inhalation injury for which the BSST was completed. The mean age of the patients was 57 ± 4 years (Mean ± SEM), and the burn size was 24 ± 15 % TBSA. Eleven patients were women (36%) and 7 patients had inhalation injury (23%). The expected case fatality was 21 - 30% depending on the statistical model used. Six patients (19%) died. The length of stay was 64 ± 10 days and ranged from 3 to 267 days. A patient was judged to be septic in only 45 of the daily encounters (8.0 % ± 1.1). There were 21 instances of a new septic event made in 12 patients. Episode of sepsis separated by at least 5 days of no sepsis, were considered to be a new septic event. There was a substantial amount of data that was missing or not applicable. There were no significant differences in the septic parameters on days with new sepsis diagnosis when compared to the day prior, or compared to all encounters in patients that were never septic. Patients deteriorated acutely between BSST completions on only two occasions and both were stabilized. Conclusions The BSST was used consistently to help evaluate the daily status of critically ill burn injured patients. The expected case fatality of the group was moderately high, based on statistical models derived from the ABA Burn Registry. The observed outcome was as good as or better than predicted. Acute decompensation was rare. The BSST added daily administrative work to rounds, and the data recorded were often incomplete. Although the BSST did not demonstrate any single clinical feature that identified the transition from SIRS to sepsis, it did add structure and rigor to daily rounds. That contributed to the effectiveness of rounds, and it may have been responsible, in part, for the favorable outcomes.

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THU0442 GOUT AND HEART FAILURE IN THE US: A NATIONAL PERSPECTIVE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3905 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 458.2-458

Author(s):

G. Singh ◽

M. Sehgal ◽

A. Mithal

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Confidence Intervals ◽

Burden Of Illness ◽

Average Length ◽

Private Insurance ◽

Significant Risk ◽

Case Fatality ◽

The United States ◽

The Us

Background:Heart failure (HF) is the eighth leading cause of death in the US, with a 38% increase in the number of deaths due to HF from 2011 to 2017 (1). Gout and hyperuricemia have previously been recognized as significant risk factors for heart failure (2), but there is little nationwide data on the clinical and economic consequences of these comorbidities.Objectives:To study heart failure hospitalizations in patients with gout in the United States (US) and estimate their clinical and economic impact.Methods:The Nationwide Inpatient Sample (NIS) is a stratified random sample of all US community hospitals. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. We examined all inpatient hospitalizations in the NIS in 2017, the most recent year of available data, with a primary or secondary diagnosis of gout and heart failure. Over 69,800 ICD 10 diagnoses were collapsed into a smaller number of clinically meaningful categories, consistent with the CDC Clinical Classification Software.Results:There were 35.8 million all-cause hospitalizations in patients in the US in 2017. Of these, 351,735 hospitalizations occurred for acute and/or chronic heart failure in patients with gout. These patients had a mean age of 73.3 years (95% confidence intervals 73.1 – 73.5 years) and were more likely to be male (63.4%). The average length of hospitalization was 6.1 days (95% confidence intervals 6.0 to 6.2 days) with a case fatality rate of 3.5% (95% confidence intervals 3.4% – 3.7%). The average cost of each hospitalization was $63,992 (95% confidence intervals $61,908 - $66,075), with a total annual national cost estimate of $22.8 billion (95% confidence intervals $21.7 billion - $24.0 billion).Conclusion:While gout and hyperuricemia have long been recognized as potential risk factors for heart failure, the aging of the US population is projected to significantly increase the burden of illness and costs of care of these comorbidities (1). This calls for an increased awareness and management of serious co-morbid conditions in patients with gout.References:[1]Sidney, S., Go, A. S., Jaffe, M. G., Solomon, M. D., Ambrosy, A. P., & Rana, J. S. (2019). Association Between Aging of the US Population and Heart Disease Mortality From 2011 to 2017. JAMA Cardiology. doi:10.1001/jamacardio.2019.4187[2]Krishnan E. Gout and the risk for incident heart failure and systolic dysfunction. BMJ Open 2012;2:e000282.doi:10.1136/bmjopen-2011-000282Disclosure of Interests: :Gurkirpal Singh Grant/research support from: Horizon Therapeutics, Maanek Sehgal: None declared, Alka Mithal: None declared

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1787. The Effects of a Systemwide Diagnostic Stewardship Change on West Nile Virus Disease Ordering Practices

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1650 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S658-S658

Author(s):

Andrew H Karaba ◽

Paul W Blair ◽

Kevin M Martin ◽

Mustapha O Saheed ◽

Karen C Carroll ◽

...

Keyword(s):

West Nile Virus ◽

Virus Disease ◽

Case Fatality ◽

Cost Savings ◽

Primary Objective ◽

Neurological Deficits ◽

West Nile ◽

Hospital System ◽

Elisa Testing ◽

Before And After

Abstract Background Neuroinvasive West Nile Virus (WNV) often leads to prolonged neurological deficits and carries a high case fatality rate. The CSF IgM (MAC-ELISA) is preferred over the CSF nucleic acid-based test (NAAT) by the CDC due to its higher sensitivity. However, our hospital system was observed to have an over-utilization of NAAT testing compared with MAC-ELISA testing. The primary objective was to compare the number of MAC-ELISA and NAAT WNV tests ordered before and after a diagnostic stewardship intervention. The secondary objectives were to determine whether this change to lead to any cost savings and increased detection of probable cases of WNV-ND. Methods In an effort to increase the use of the MAC-ELISA and to decrease unnecessary NAAT testing, the NAAT test was removed in April 2018 from the test menu in the electronic health record of a health system comprising five hospitals in the Maryland and Washington, D.C. area. NAAT testing remained possible via a paper order form. This study was a retrospective review of WNV testing done on CSF samples from July 2016 through December 2018. The seasonal and yearly number of total tests, positive tests, and total costs were determined from the period of July, 2017 to April, 2018 and were compared with May, 2018 to January, 2019. A paired t-test was performed to evaluate for differences in total testing, total positives, and total costs during non-winter months before and after the intervention. Results A total of 12.59 MAC-ELISA tests/month (95% CI: 10.29, 14.89) increased to 41 tests/month (95% CI: 34.35, 47.65) which was significantly different (P < 0.001). In contrast, there were 46.23 NAAT tests/month (95% CI: 39.55, 52.91) which decreased to 0 NAAT tests/month after the intervention (P < 0.001). This resulted in an average decrease in WNV test spending from $7200 per month to $471 per month (P < 0.001). Preceding the intervention in test ordering, 0.23% of WNV CSF tests were positive (NAAT+MAC-ELISA) while 2.44% WNV CSF tests were positive after the intervention (P = 0.03). Conclusion Elimination of electronic WNV NAAT ordering is an effective way of decreasing inappropriate WNV NAAT testing, decreasing associated costs, and may lead to improved diagnosis of WNV-ND. Disclosures All authors: No reported disclosures.

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