Document Detail


Critically ill patients with severe acute respiratory syndrome.
MedLine Citation:
PMID:  12865378     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Severe acute respiratory syndrome (SARS) is a newly recognized infectious disease capable of causing severe respiratory failure.
OBJECTIVE: To determine the epidemiological features, course, and outcomes of patients with SARS-related critical illness.
DESIGN, SETTING, AND PATIENTS: Retrospective case series of 38 adult patients with SARS-related critical illness admitted to 13 intensive care units (ICUs) in the Toronto area between the onset of the outbreak and April 15, 2003. Data were collected daily during the first 7 days in the ICUs, and patients were followed up for 28 days.
MAIN OUTCOME MEASURES: The primary outcome was mortality at 28 days after ICU admission. Secondary outcomes included rate of SARS-related critical illness, number of tertiary care ICUs and staff placed under quarantine, and number of health care workers (HCWs) contracting SARS secondary to ICU-acquired transmission.
RESULTS: Of 196 patients with SARS, 38 (19%) became critically ill, 7 (18%) of whom were HCWs. The median (interquartile range [IQR]) age of the 38 patients was 57.4 (39.0-69.6) years. The median (IQR) duration between initial symptoms and admission to the ICU was 8 (5-10) days. Twenty-nine (76%) required mechanical ventilation and 10 of these (34%) experienced barotrauma. Mortality at 28 days was 13 (34%) of 38 patients and for those requiring mechanical ventilation, mortality was 13 (45%) of 29. Six patients (16%) remained mechanically ventilated at 28 days. Two of these patients had died by 8 weeks' follow-up. Patients who died were more often older, had preexisting diabetes mellitus, and on admission to hospital were more likely to have bilateral radiographic infiltrates. Transmission of SARS in 6 study ICUs led to closure of 73 medical-surgical ICU beds. In 2 university ICUs, 164 HCWs were quarantined and 16 (10%) developed SARS.
CONCLUSIONS: Critical illness was common among patients with SARS. Affected patients had primarily single-organ respiratory failure, and half of mechanically ventilated patients died. The SARS outbreak greatly strained regional critical care resources.
Authors:
Robert A Fowler; Stephen E Lapinsky; David Hallett; Allan S Detsky; William J Sibbald; Arthur S Slutsky; Thomas E Stewart;
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  JAMA     Volume:  290     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2003 Jul 
Date Detail:
Created Date:  2003-07-16     Completed Date:  2003-07-18     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  367-73     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
APACHE
Adult
Aged
Barotrauma / microbiology,  therapy
Communicable Diseases, Emerging
Comorbidity
Disease Outbreaks
Disease Progression
Female
Humans
Infection Control
Infectious Disease Transmission, Patient-to-Professional
Intensive Care
Intensive Care Units*
Lung Diseases, Interstitial / microbiology,  therapy
Male
Middle Aged
Multiple Organ Failure / microbiology
Ontario / epidemiology
Respiration, Artificial
Respiratory Distress Syndrome, Adult / microbiology,  therapy
Retrospective Studies
Severe Acute Respiratory Syndrome* / complications,  epidemiology,  physiopathology,  therapy,  transmission
Survival Analysis
Time Factors
Treatment Outcome
Comments/Corrections
Comment In:
ACP J Club. 2004 Jan-Feb;140(1):20   [PMID:  14711291 ]
JAMA. 2003 Jul 16;290(3):397-9   [PMID:  12865383 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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