New evidence helps health workers combat Ebola

Researchers have found new ways to help Ebola health workers address one of their toughest areas of care - keeping seriously ill patients hydrated.
A review published in the Cochrane Library compared the different ways of giving fluids to patients who need fluids but are too ill to drink enough.
Many patients with Ebola Virus Disease (EVD) die because they are dehydrated. Patients with EVD often experience severe vomiting and diarrhoea, which causes them to lose fluids which are difficult to replace by drinking alone.
The review compares the different ways to give fluids to people in situations where it is impossible to maintain adequate hydration simply by giving fluids orally.

Collectively, these alternatives are termed parenteral access. They include getting fluids into a vein (intravenously), into bone marrow (intraosseously), into fatty tissue under the skin (subcutaneously) or into the abdominal space (intraperitoneally).
Giving fluids intravenously is a commonly used method, but in patients with Ebola this can be problematic.

Obtaining venous access can be difficult in very dehydrated patients, and this is made even worse in situations where care-givers are obliged to wear protective suits, and where there is a risk of transmission of the virus, such as Ebola.
The review helps health workers caring for patients with EVD to know the advantages and disadvantages of the other ways to give fluids, so they can decide which is the most suitable for their patients.

The review included 17 studies involving 885 people. However, the trials were of low quality, so the authors suggest the need for caution when drawing conclusions based on these results.
"This Cochrane review shows us that if intravenous access can be achieved easily, then this should be used as it allows the infusion of larger volumes of fluid. However, if intravenous access is not possible, intraosseous and subcutaneous routes are alternatives that can be inserted quickly," Katharine Ker, from The London School of Hygiene and Tropical Medicine, said.