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. 2004;6(3):228. doi: 10.1007/s11908-004-0013-6

SARS in the intensive care unit

Gavin M Joynt 1, H Y Yap
PMCID: PMC7089324  PMID: 15142487

Abstract

Approximately 20% of patients with severe acute respiratory syndrome (SARS) develop respiratory failure that requires admission to an intensive care unit (ICU). Old age, comorbidity, and elevated lactate dehydrogenase on hospital admission are associated with increased risk for ICU admission. ICU admission usually is late and occurs 8 to 10 days after symptom onset. Acute respiratory distress syndrome occurs in almost all admitted patients and most require mechanical ventilation. ICU admission is associated with significant morbidity, particularly an apparent increase in the incidence of barotrauma and nosocomial sepsis. Long-term mortality for patients admitted to the ICU ranges from 30% to 50%. Many procedures in ICUs pose a high risk for transmission of SARS coronavirus to health care workers. Contact and airborne infection isolation precautions, in addition to standard precautions, should be applied when caring for patients with SARS. Ensuring staff safety is important to maintain staff morale and delivery of adequate services.

Keywords: Acute Respiratory Distress Syndrome, Intensive Care Unit Admission, Severe Acute Respiratory Syndrome, Severe Acute Respiratory Syndrome, Hand Hygiene Compliance

References and Recommended Reading

  • 1.Fouchier RA, Kuiken T, Schutten M, et al. Aetiology: Koch’s postulates fulfilled for SARS virus. Nature. 2003;423:240–240. doi: 10.1038/423240a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.World Health Organization: Summary table of SARS cases by country, 1 November 2002–7 August 2003. http:// www.who.int/csr/sars/country/table2003_09_23/en/. Accessed January 8, 2004.
  • 3.Cluster of severe acute respiratory syndrome cases among protected health-care workers--Toronto, Canada, April 2003. Morb Mortal Wkly Rep 2003, 52:433-436. [PubMed]
  • 4.Fowler RA, Lapinsky SE, Hallett D, et al. Critically ill patients with severe acute respiratory syndrome. JAMA. 2003;290:367–373. doi: 10.1001/jama.290.3.367. [DOI] [PubMed] [Google Scholar]
  • 5.Lew TW, Kwek TK, Tai D, et al. Acute respiratory distress syndrome in critically ill patients with severe acute respiratory syndrome. JAMA. 2003;290:374–380. doi: 10.1001/jama.290.3.374. [DOI] [PubMed] [Google Scholar]
  • 6.Booth CM, Matukas LM, Tomlinson GA, et al. Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area. JAMA. 2003;289:2801–2809. doi: 10.1001/jama.289.21.JOC30885. [DOI] [PubMed] [Google Scholar]
  • 7.Lee N, Hui D, Wu A, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Eng J Med. 2003;348:1986–1994. doi: 10.1056/NEJMoa030685. [DOI] [PubMed] [Google Scholar]
  • 8.Peiris JS, Chu CM, Cheng VC, et al. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet. 2003;361:1767–1772. doi: 10.1016/S0140-6736(03)13412-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Choi KW, Chau TN, Tsang O, et al. Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong. Ann Intern Med. 2003;139:715–723. doi: 10.7326/0003-4819-139-9-200311040-00005. [DOI] [PubMed] [Google Scholar]
  • 10.Peiris JS, Yuen KY, Osterhaus AD, Stohr K. The severe acute respiratory syndrome. N Engl J Med. 2003;349:2431–2441. doi: 10.1056/NEJMra032498. [DOI] [PubMed] [Google Scholar]
  • 11.Gomersall CD, Joynt GM, Lam P, et al. Short-term outcome of critically ill patients with severe acute respiratory syndrome. Intensive Care Med. 2004;30:381–387. doi: 10.1007/s00134-003-2143-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Bernard GR, Artigas A, Brigham KL, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149:818–824. doi: 10.1164/ajrccm.149.3.7509706. [DOI] [PubMed] [Google Scholar]
  • 13.Tsui PT, Kwok ML, Yuen H, Lai ST. Severe acute respiratory syndrome: clinical outcome and prognostic correlates. Emerg Infect Dis. 2003;9:1064–1069. doi: 10.3201/eid0909.030362. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Nicholls JM, Poon LL, Lee KC, et al. Lung pathology of fatal severe acute respiratory syndrome. Lancet. 2003;361:1773–1778. doi: 10.1016/S0140-6736(03)13413-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Ning Q, Brown D, Parodo J, et al. Ribavirin inhibits viralinduced macrophage production of TNF, IL-1, the procoagulant fg12 prothrombinase and preserves Th1 cytokine production but inhibits Th2 cytokine response. J Immunol. 1998;160:3487–3493. [PubMed] [Google Scholar]
  • 16.Chu CM, Cheng VC, Hung IF, et al. The role of lopinavir/ ritonavir in the treatment of SARS: initial virological and clinical findings. Thorax. 2004;59:252–256. doi: 10.1136/thorax.2003.012658. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Hsu LY, Lee CC, Green JA, et al. Severe acute respiratory syndrome (SARS) in Singapore: clinical features of index patient and initial contacts. Emerg Infect Dis. 2003;9:713–717. doi: 10.3201/eid0906.030264. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Chan KS, Lai ST, Chu CM. Treatment of severe acute respiratory syndrome with lopinavir/ritonavir: a multicentre retrospective matched cohort study. Hong Kong Med J. 2003;9:399–406. [PubMed] [Google Scholar]
  • 19.Zhao Z, Zhang F, Xu M, et al. Description and clinical treatment of an early outbreak of severe acute respiratory syndrome (SARS) in Guangzhou, PR China. J Med Microbiol. 2003;52:715–720. doi: 10.1099/jmm.0.05320-0. [DOI] [PubMed] [Google Scholar]
  • 20.So LK, Lau AC, Yam LY, et al. Development of a standard treatment protocol for severe acute respiratory syndrome. Lancet. 2003;361:1615–1617. doi: 10.1016/S0140-6736(03)13265-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Ho JC, Ooi GC, Mok TY, et al. High dose pulse versus nonpulse corticosteroid regimens in severe acute respiratory syndrome. Am J Respir Crit Care Med. 2003;168:1449–1456. doi: 10.1164/rccm.200306-766OC. [DOI] [PubMed] [Google Scholar]
  • 22.Sung JJY, Wu A, Joynt GM, et al.: Severe acute respiratory syndrome: report of treatment and outcome after a major outbreak. Thorax 2004, In press. [DOI] [PMC free article] [PubMed]
  • 23.Thompson BT. Glucocorticoids and acute lung injury. Crit Care Med. 2003;31:S253–S257. doi: 10.1097/01.CCM.0000057900.19201.55. [DOI] [PubMed] [Google Scholar]
  • 24.Meduri GU, Headley AS, Golden E, et al. Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: a randomized controlled trial. JAMA. 1998;280:159–165. doi: 10.1001/jama.280.2.159. [DOI] [PubMed] [Google Scholar]
  • 25.Brun-Buisson C, Brochard L. Corticosteroid therapy in acute respiratory distress syndrome: better late than never. JAMA. 1998;280:182–183. doi: 10.1001/jama.280.2.182. [DOI] [PubMed] [Google Scholar]
  • 26.Antonio GE, Wong KT, Chu WC, et al. Imaging in severe acute respiratory syndrome (SARS) Clin Radiol. 2003;58:825–832. doi: 10.1016/S0009-9260(03)00308-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Cordingley JJ, Keogh BF. The pulmonary physician in critical care: ventilatory management of ALI/ARDS. Thorax. 2002;8:729–734. doi: 10.1136/thorax.57.8.729. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Gattinoni L, Chiumello D, Russo R. Reduced tidal volumes and lung protective ventilatory strategies: where do we go from here? Curr Opin Crit Care. 2002;8:45–50. doi: 10.1097/00075198-200202000-00008. [DOI] [PubMed] [Google Scholar]
  • 29.Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. New Engl J Med 2000, 342:1301-1308. This is the first randomized controlled trial that showed ventilation with low tidal volumes reduces mortality. [DOI] [PubMed]
  • 30.Eichacker PQ, Gerstenberger EP, Banks SM, et al. Meta-analysis of acute lung injury and acute respiratory distress syndrome trials testing low tidal volumes. Am J Respir Crit Care Med. 2002;166:1510–1514. doi: 10.1164/rccm.200208-956OC. [DOI] [PubMed] [Google Scholar]
  • 31.Ward NS. Effects of prone position ventilation in ARDS. An evidence-based review of the literature. Crit Care Clin. 2002;18:35–44. doi: 10.1016/S0749-0704(03)00063-0. [DOI] [PubMed] [Google Scholar]
  • 32.Gattinoni L, Tognoni G, Pesenti A, et al. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med. 2001;345:568–573. doi: 10.1056/NEJMoa010043. [DOI] [PubMed] [Google Scholar]
  • 33.Pelosi P, Gattinoni L. Acute respiratory distress syndrome of pulmonary and extra-pulmonary origin: fancy or reality? Intensive Care Med. 2001;27:457–460. doi: 10.1007/s001340100879. [DOI] [PubMed] [Google Scholar]
  • 34.Gattinoni L, Pelosi P, Suter PM, et al. Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med. 1998;158:3–11. doi: 10.1164/ajrccm.158.1.9708031. [DOI] [PubMed] [Google Scholar]
  • 35.Lim CM, Kim EK, Lee JS, et al. Comparison of the response to the prone position between pulmonary and extrapulmonary acute respiratory distress syndrome. Intensive Care Med. 2001;27:477–485. doi: 10.1007/s001340000848. [DOI] [PubMed] [Google Scholar]
  • 36.Dellinger RP, Zimmerman JL, Taylor RW, et al. Effects of inhaled nitric oxide in patients with acute respiratory distress syndrome: results of a randomized phase II trial. Inhaled Nitric Oxide in ARDS Study Group. Crit Care Med. 1998;26:15–23. doi: 10.1097/00003246-199801000-00011. [DOI] [PubMed] [Google Scholar]
  • 37.Humphrey H, Hall J, Sznajder I, et al. Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure. Chest. 1990;97:1176–1180. doi: 10.1378/chest.97.5.1176. [DOI] [PubMed] [Google Scholar]
  • 38.Mitchell JP, Schuller D, Calandrino FS, et al. Improved outcome based on fluid management in critically ill patients requiring pulmonary catheter catheterization. Am Rev Respir Dis. 1992;145:990–998. doi: 10.1164/ajrccm/145.5.990. [DOI] [PubMed] [Google Scholar]
  • 39.Joynt GM, Antonio GE, Lam P, et al. Thin-section computed tomography abnormalities in patients with late adult respiratory distress syndrome (ARDS) caused by severe acute respiratory syndrome (SARS) Radiology. 2004;230:339–346. doi: 10.1148/radiol.2303030894. [DOI] [PubMed] [Google Scholar]
  • 40.Pittet D. Improving compliance with hand hygiene in hospitals. Infect Control Hosp Epidemiol. 2000;21:381–386. doi: 10.1086/501777. [DOI] [PubMed] [Google Scholar]
  • 41.Herridge MS, Cheung AM, Tansey CM, et al. One-year outcomes in survivors of the ARDS. N Engl J Med. 2003;348:683–693. doi: 10.1056/NEJMoa022450. [DOI] [PubMed] [Google Scholar]
  • 42.Severe acute respiratory syndrome (SARS). Centers for Disease Control and Prevention, 2003. http://www.cdc.gov/ncidod/ sars. Accessed January 8, 2004. This contains detailed guidelines on infection control for SARS.
  • 43.World Health Organization: Hospital infection control guidance for severe acute respiratory syndrome (SARS). http://www.who.int/csr/sars/infectioncontrol/en. Accessed April 11, 2003.
  • 44.Gomersall CD, Joynt GM: Severe acute respiratory syndrome (SARS). http://www.aic.cuhk.hk/web8/sars.htm. Accessed January 8, 2004.
  • 45.Li TS, Buckley TA, Yap FH, et al. Severe acute respiratory syndrome (SARS): infection control. Lancet. 2003;361:1386–1386. doi: 10.1016/S0140-6736(03)13052-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 46.Drosten C, Gunther S, Preiser W, et al. Identification of a novel coronavirus in patients with severe acute respiratory syndrome. N Engl J Med. 2003;348:1967–1976. doi: 10.1056/NEJMoa030747. [DOI] [PubMed] [Google Scholar]
  • 47.Tomlinson B, Cockram C. SARS: experience at Prince of Wales Hospital, Hong Kong. Lancet. 2003;361:1486–1487. doi: 10.1016/S0140-6736(03)13218-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 48.Hong Kong Department of Health Report. Main findings of an investigation into the outbreak of severe acute respiratory syndrome at Amoy Gardens. http://www.info.gov.hk/dh/ ap.htm. Accessed April 19, 2003.
  • 49.Garner JS, Hospital Infection Control Practices Advisory Committee Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol. 1996;17:53–80. doi: 10.1086/647190. [DOI] [PubMed] [Google Scholar]
  • 50.Respiratory Protection Program. US Department of Labor. Occupational Safety and Health Administration. http://www.osha.gov/SLTC/etools/respiratory. Accessed January 8, 2004.
  • 51.Hospital infection control guidance for severe acute respiratory syndrome (SARS). http://www.who.int/csr/sars/infectioncontrol/ en. Accessed April 11, 2003.

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