›Added if norepinephrine dose > 0.25 mcg/kg/min
›Steroid-sparing and NE-sparing effect
›Stress dose hydrocortisone
›200 mg/day IV continuous or divided doses
›If refractory shock on vasopressors
›Surviving Sepsis Campaign Class IIb recommendation
Antiviral and investigational therapeutics
›Remdesivir (investigational in MVD)
›Nucleotide analogue antiviral
›IV administration to critically ill patients
›200 mg IV loading dose on day 1
›100 mg IV daily for 5 to 10 days
›Evidence base
›Well-tolerated in clinical use for MVD
›Used as post-exposure prophylaxis for healthcare workers in Rwanda 2024
›No approved indication; compassionate use or trial basis
›Monitoring
›Renal and hepatic function monitoring
›Drug interactions review
›MBP091 monoclonal antibody
›Targeting Marburg virus glycoprotein
›Investigational; emerging clinical use
›Access through clinical trial or compassionate use
›Administration
›IV administration per trial protocol
›Concomitant with supportive care
›No approved antiviral treatments for MVD currently
›Access through WHO or national emergency use authorization
›Enrol in trials when available
›Supportive care remains mainstay
Haemorrhage and coagulopathy management
›Thrombocytopenia and bleeding management
›Platelet transfusion thresholds
›Platelets < 10 x 10^9/l: transfuse regardless
›Platelets < 50 x 10^9/l with active bleeding: transfuse
›Single dose transfusion with post-transfusion recheck
›Fresh frozen plasma for coagulopathy
›INR > 1.5 with active bleeding
›15 ml/kg IV
›Target INR < 1.5 for invasive procedures
›Cryoprecipitate for low fibrinogen
›Fibrinogen < 1.5 g/l with bleeding
›1 pool per 10 kg body weight
›Avoid unnecessary invasive procedures
›Heightened risk of uncontrolled bleeding
›Increased nosocomial transmission risk
Secondary infection management
›Empirical antibiotics for bacterial superinfection
›Broad-spectrum coverage when clinical suspicion high
›Piperacillin-tazobactam 4.5 g IV every 6 hours
›Ceftriaxone 2 g IV daily as alternative
›MRSA coverage if risk factors present
›Vancomycin 15 to 20 mg/kg IV every 8 to 12 hours
›AUC-guided dosing preferred
›Antifungal therapy for suspected fungal superinfection
›Fluconazole 400 mg IV daily for Candida risk
›Micafungin 100 mg IV daily for refractory cases
›Malaria co-treatment
›Empirical malaria treatment in endemic area patients
›Artemether-lumefantrine PO if able to swallow
›IV artesunate for severe or parenteral-requiring malaria
›Positive RDT or smear confirms; treat empirically while awaiting MVD result
›Renal replacement therapy
›Indications for dialysis
›Refractory oliguria or anuria
›Serum creatinine rising with fluid overload
›Metabolic acidosis not responding to resuscitation
›Continuous renal replacement therapy preferred in haemodynamic instability
›CVVH or CVVHDF
›Full PPE during circuit setup and maintenance
›Mechanical ventilation
›Lung protective strategy
›Tidal volume 6 ml/kg ideal body weight
›Plateau pressure < 30 cmH2O
›PEEP titrated to oxygenation and haemodynamics
›Prone positioning for ARDS
›PaO2/FiO2 < 150 mmHg as threshold
›16 hours prone per day
›Aerosol generating procedure PPE
›Powered air purifying respirator if available
›Limit personnel during intubation