Ebola Virus Disease with Hypoxic Respiratory Failure: Escalation When Oxygen Therapy Fails to Reach SpO2 > 94%
In Ebola virus disease (EVD), hypoxaemia (SpO2 < 92%) or hypoxic respiratory failure is a serious complication. When initial oxygen therapy does not sustain the target oxygen saturation, a structured next-step approach is indicated.
Hypoxaemia (SpO2 < 92%) or hypoxic respiratory failure in the setting of EVD. When hypoxaemia is present, an underlying pulmonary cause should be considered — including volume overload or pulmonary oedema, secondary bacterial pneumonia, haemothorax, or bronchospasm.
This protocol applies after oxygen therapy — via face mask with reservoir bag or nasal cannula — has been used and peripheral oxygen saturation (SpO2) > 94% has not been achieved or maintained.
When severe hypoxaemia persists despite prior oxygen therapy, a form of non-invasive respiratory support delivering positive pressure may be considered. The full escalation criteria, selection guidance, and monitoring requirements are available in the complete protocol.
Treatment goal: Achieve and maintain peripheral oxygen saturation (SpO2) > 94%.
References
When hypoxaemia is present, then a pulmonary condition should be considered, such as volume overload/pulmonary oedema from congestive heart failure or renal failure, secondary bacterial pneumonia, haemothorax or bronchospasm from anaphylaxis.
If severe hypoxaemia persists, then consider continuous positive airway pressure or high flow oxygen systems.
Titrate to lowest flow rate necessary to reach target SpO2 > 94%.
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