Treatment of Ebola Virus Disease with Low Systolic Blood Pressure When Fluid Resuscitation Has Not Restored Perfusion

Clinical scenario

This protocol applies to patients with confirmed or suspected Ebola virus disease who remain in shock after initial resuscitation efforts. The shock criteria differ by age:

Adults: systolic blood pressure below 90 mm Hg, or other clinical signs of hypoperfusion. Children: delayed capillary refill greater than 3 seconds, cold extremities, weak rapid pulse, or hypotension for age.

After initial shock management — when perfusion targets are not met

The preceding step — oxygen therapy, isotonic crystalloid fluid boluses, and empiric antimicrobials — aims to restore the following perfusion markers, reassessed every 30 minutes: sustained systolic blood pressure above 90–100 mm Hg in adults (age-appropriate in children), SpO₂ above 94%, adequate urine output, normal respiratory rate, and strong pulse with brisk capillary refill.

When repeated fluid boluses fail to achieve those targets, escalation to vasopressor support is indicated.

Next-line approach

Vasopressor infusion is the indicated next intervention. The choice of agent differs between adults and children; the full selection criteria, preferred options, and titration algorithm are in the structured protocol.

Treatment goal: restore and maintain systolic blood pressure above 90–100 mm Hg (MAP above 65 mm Hg) in adults, and age-appropriate blood pressure and perfusion markers in children.

Instant Access to Structured Evidence-Based Regimens

References

Shock in adult: SBP < 90 mm HG, mean arterial blood pressure < 65 mm Hg or other clinical signs of hypoperfusion.

Shock in child: delayed capillary refill > 3 seconds, cold extremities, weak rapid pulse or hypotension for age (SBP < 70 + (age in years x 2)).

For adults, noradrenaline is the first-line vasopressor for shock.

For children, epinephrine is first-line vasopressor for shock. The alternative is noradrenaline.

Vasopressors can be started during fluid resuscitation and weaned as a patient responds to volume resuscitation to maintain SBP > 90–100 mm Hg in adults (or MAP > 65 mm Hg), and age-appropriate blood pressure and perfusion markers in children.

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