Bibliographic information
GuidelineWHO guidelines for the clinical management of filovirus disease
Year of Publication2026
Issuing InstitutionWorld Health Organization
Recommendation
New
WHO recommends that patients with suspected or confirmed filovirus disease requiring a vasopressor be treated with norepinephrine rather than dopamine.
Recommended in favor
Strong
Certainty of evidence
Moderate
Notes and Remarks
- This recommendation applies to children and adults, including pregnant women. • Vasopressors should be used within a resuscitation strategy that includes: appropriate intravenous fluid therapy; frequent monitoring, including for cardiac arrhythmia. • Individualize titration of the dose to desired effect (targeting arterial pressure as an indicator of perfusion). • To minimize adverse effects, use the lowest dose possible for desired effect and discontinue vasopressors when no longer indicated. Practical info General considerations
- Establish large bore veinous access (16–18 gauge catheter) or intraosseous line or central venous catheter.
- Appropriate dilution in selected carrier and precise delivery mechanism, such as infusion pumps.
- Establish close haemodynamic monitoring, and adequate staffing to provide close monitoring.
- Close monitoring of the intravenous site is mandatory to identify any signs of extravasation:
- lf signs of extravasation, administer 5–10 mL of phentolamine diluted in 10 mL of 0.9% sodium chloride subcutaneously at the venous access site.
- Use the lowest dose necessary to achieve perfusion target. Check markers of perfusion every 30 minutes. To make up norepinephrine and epinephrine solutions:
- Adults: add 4 mL of 1:1000 norepinephrine/epinephrine to 46 mL of 5% w/v dextrose solution to make 50 mL of 80 µg/mL concentration.
- Children: use a more dilute solutions. Add 1 mL of 1:1000 norepinephrine/epinephrine to 49 mL of 5% w/v dextrose solution to make 50 mL of 20 µg/mL concentration.
- Peripheral administration: use a more dilute solution (equivalent to that used centrally for children). Add 1 mL of 1:1000 norepinephrine to 49 mL of 5% w/v dextrose solution to make 50 mL of 20 µg/mL concentration. For both norepinephrine and epinephrine administered through a central vein, start at 0.05 μg/kg/min and increase the dose in increments of 0.1 μg/kg/min, up to a maximum of 0.5–0.75 μg/kg/min. When administered through a peripheral vein, use the same dosing regimen but prepare a dilute solution with a concentration of 20 μg/mL.