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Severe acute respiratory distress syndrome (SARS): a critical care perspective.
Crit Care Med. 2003 Nov; 31(11):2684-92.CC

Abstract

OBJECTIVE

To review the epidemiology, clinical features, etiology, diagnosis, and management of severe acute respiratory syndrome (SARS) from a critical care perspective.

DATA SOURCES

A MEDLINE search was performed using the following terms: severe acute respiratory syndrome and SARS virus. Additional information and references were obtained from the Web sites for the Centers for Disease Control and Prevention, World Health Organization, and Health Canada.

STUDY SELECTION

Recent case series were used to develop a review of the epidemiology, clinical features, outcomes, and management of patients with SARS from an intensive care unit (ICU) perspective. This was supplemented by epidemiology information obtained from other Web-based sources. Recent published studies describing the etiology of SARS were also included.

DATA SYNTHESIS

SARS has rapidly spread from Southeast Asia to numerous countries, including Canada and the United States. A new coronavirus has been isolated and detected from many affected patients. The mortality rate worldwide is approximately 10.5%. From five cohorts, the ICU admission rate ranged from 20% to 38%. Fifty-nine percent to 100% of the ICU patients required mechanical ventilatory support. The mortality rate of SARS patients admitted to the ICU ranged from 5% to 67%. The most common clinical symptoms and signs are fever, cough, dyspnea, myalgias, malaise, and inspiratory crackles. Common laboratory abnormalities included mild leukopenia, lymphopenia, and increased aspartate transaminase, alanine transaminase, lactic dehydrogenase, and creatine kinase. The chest radiograph pattern ranged from focal infiltrates to diffuse airspace disease. Management consisted of isolation, strict respiratory and contact precautions, ventilatory support as needed, empiric broad-spectrum antibiotics, ribavirin, and corticosteroids. Predictors of mortality included advanced age, the presence of comorbidities, and a high lactic dehydrogenase or high neutrophil count at admission.

CONCLUSIONS

SARS is a highly contagious, infectious process that can advance to significant hypoxemic respiratory failure requiring ICU monitoring and support. Early recognition is critical for effective management and containment of this disease.

Authors+Show Affiliations

Department of Medicine, University of British Columbia, Vancouver, Canada.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

14605542

Citation

Manocha, Sanjay, et al. "Severe Acute Respiratory Distress Syndrome (SARS): a Critical Care Perspective." Critical Care Medicine, vol. 31, no. 11, 2003, pp. 2684-92.
Manocha S, Walley KR, Russell JA. Severe acute respiratory distress syndrome (SARS): a critical care perspective. Crit Care Med. 2003;31(11):2684-92.
Manocha, S., Walley, K. R., & Russell, J. A. (2003). Severe acute respiratory distress syndrome (SARS): a critical care perspective. Critical Care Medicine, 31(11), 2684-92.
Manocha S, Walley KR, Russell JA. Severe Acute Respiratory Distress Syndrome (SARS): a Critical Care Perspective. Crit Care Med. 2003;31(11):2684-92. PubMed PMID: 14605542.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Severe acute respiratory distress syndrome (SARS): a critical care perspective. AU - Manocha,Sanjay, AU - Walley,Keith R, AU - Russell,James A, PY - 2003/11/8/pubmed PY - 2003/12/12/medline PY - 2003/11/8/entrez SP - 2684 EP - 92 JF - Critical care medicine JO - Crit Care Med VL - 31 IS - 11 N2 - OBJECTIVE: To review the epidemiology, clinical features, etiology, diagnosis, and management of severe acute respiratory syndrome (SARS) from a critical care perspective. DATA SOURCES: A MEDLINE search was performed using the following terms: severe acute respiratory syndrome and SARS virus. Additional information and references were obtained from the Web sites for the Centers for Disease Control and Prevention, World Health Organization, and Health Canada. STUDY SELECTION: Recent case series were used to develop a review of the epidemiology, clinical features, outcomes, and management of patients with SARS from an intensive care unit (ICU) perspective. This was supplemented by epidemiology information obtained from other Web-based sources. Recent published studies describing the etiology of SARS were also included. DATA SYNTHESIS: SARS has rapidly spread from Southeast Asia to numerous countries, including Canada and the United States. A new coronavirus has been isolated and detected from many affected patients. The mortality rate worldwide is approximately 10.5%. From five cohorts, the ICU admission rate ranged from 20% to 38%. Fifty-nine percent to 100% of the ICU patients required mechanical ventilatory support. The mortality rate of SARS patients admitted to the ICU ranged from 5% to 67%. The most common clinical symptoms and signs are fever, cough, dyspnea, myalgias, malaise, and inspiratory crackles. Common laboratory abnormalities included mild leukopenia, lymphopenia, and increased aspartate transaminase, alanine transaminase, lactic dehydrogenase, and creatine kinase. The chest radiograph pattern ranged from focal infiltrates to diffuse airspace disease. Management consisted of isolation, strict respiratory and contact precautions, ventilatory support as needed, empiric broad-spectrum antibiotics, ribavirin, and corticosteroids. Predictors of mortality included advanced age, the presence of comorbidities, and a high lactic dehydrogenase or high neutrophil count at admission. CONCLUSIONS: SARS is a highly contagious, infectious process that can advance to significant hypoxemic respiratory failure requiring ICU monitoring and support. Early recognition is critical for effective management and containment of this disease. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/14605542/Severe_acute_respiratory_distress_syndrome__SARS_:_a_critical_care_perspective_ L2 - https://dx.doi.org/10.1097/01.CCM.0000091929.51288.5F DB - PRIME DP - Unbound Medicine ER -