Acute respiratory distress syndrome in critically ill patients with severe acute respiratory syndrome.

CONTEXT Severe acute respiratory syndrome (SARS) is an emerging infectious disease with a 25% incidence of progression to acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) and mortality exceeding 10%. OBJECTIVE To describe the clinical spectrum and outcomes of ALI/ARDS in patients with SARS-related critical illness. DESIGN, SETTING, AND PATIENTS Retrospective case series of adult patients with probable SARS admitted to the intensive care unit (ICU) of a hospital in Singapore between March 6 and June 6, 2003. MAIN OUTCOME MEASURES The primary outcome measure was 28-day mortality after symptom onset. RESULTS Of 199 patients hospitalized with SARS, 46 (23%) were admitted to the ICU, including 45 who fulfilled criteria for ALI/ARDS. Mortality at 28 days for the entire cohort was 20 (10.1%) of 199 and for ICU patients was 17 (37%) of 46. Intensive care unit mortality at 13 weeks was 24 (52.2%) of 46. Nineteen of 24 ICU deaths occurred late (> or =7 days after ICU admission) and were attributed to complications related to severe ARDS, multiorgan failure, thromboembolic complications, or septicemic shock. ARDS was characterized by ease of derecruitment of alveoli and paucity of airway secretion, bronchospasm, or dynamic hyperinflation. Lower Acute Physiology and Chronic Health Evaluation II scores and higher baseline ratios of PaO2 to fraction of inspired oxygen were associated with earlier recovery. CONCLUSIONS Critically ill patients with SARS and ALI/ARDS had characteristic clinical findings, high rates of complications; and high mortality. These findings may provide useful information for optimizing supportive care for SARS-related critical illness.

[1]  M. Lamy,et al.  The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. , 1994, American journal of respiratory and critical care medicine.

[2]  R. Bone,et al.  An early test of survival in patients with the adult respiratory distress syndrome. The PaO2/FIo2 ratio and its differential response to conventional therapy. Prostaglandin E1 Study Group. , 1989, Chest.

[3]  Y. Leo,et al.  Severe Acute Respiratory Syndrome (SARS) in Singapore: Clinical Features of Index Patient and Initial Contacts , 2003, Emerging infectious diseases.

[4]  Christian Drosten,et al.  Characterization of a Novel Coronavirus Associated with Severe Acute Respiratory Syndrome , 2003, Science.

[5]  J. Vincent,et al.  Epidemiology and outcome of acute respiratory failure in intensive care unit patients , 2003, Critical care medicine.

[6]  Elizabeth Rea,et al.  Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area. , 2003, JAMA.

[7]  D. Schoenfeld,et al.  Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. , 2000, The New England journal of medicine.

[8]  R. Lemanske.  Viruses and asthma: Inception, exacerbation, and possible prevention. , 2003, The Journal of pediatrics.

[9]  J. Murray,et al.  Ineffectiveness of high-dose methylprednisolone in preventing parenchymal lung injury and improving mortality in patients with septic shock. , 1988, The American review of respiratory disease.

[10]  L. Poon,et al.  Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia : a prospective study , 2003 .

[11]  Peter Cameron,et al.  A major outbreak of severe acute respiratory syndrome in Hong Kong. , 2003, The New England journal of medicine.

[12]  E. Emanuel,et al.  Severe acute respiratory syndrome: providing care in the face of uncertainty. , 2003, JAMA.

[13]  J. Vincent,et al.  Is outcome from ARDS related to the severity of respiratory failure? , 1997, The European respiratory journal.

[14]  Yi Guan,et al.  Lung pathology of fatal severe acute respiratory syndrome , 2003, The Lancet.

[15]  L. Hudson,et al.  Causes of Mortality in Patients with the Adult Respiratory Distress Syndrome , 1985, The American review of respiratory disease.

[16]  Andrew D Bersten,et al.  Incidence and mortality of acute lung injury and the acute respiratory distress syndrome in three Australian States. , 2002, American journal of respiratory and critical care medicine.

[17]  C. Fraser,et al.  Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong , 2003, The Lancet.

[18]  Stephen E. Lapinsky,et al.  Evaluation of a Ventilation Strategy to Prevent Barotrauma in Patients at High Risk for Acute Respiratory Distress Syndrome , 1999 .

[19]  F Lemaire,et al.  Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. The Multicenter Trail Group on Tidal Volume reduction in ARDS. , 1998, American journal of respiratory and critical care medicine.

[20]  C. Sprung,et al.  High-dose corticosteroids in patients with the adult respiratory distress syndrome. , 1987, The New England journal of medicine.