PMID- 12865378
OWN - NLM
STAT- MEDLINE
DCOM- 20030718
LR  - 20201208
IS  - 1538-3598 (Electronic)
IS  - 0098-7484 (Linking)
VI  - 290
IP  - 3
DP  - 2003 Jul 16
TI  - Critically ill patients with severe acute respiratory syndrome.
PG  - 367-73
AB  - 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.
FAU - Fowler, Robert A
AU  - Fowler RA
AD  - Interdepartmental Division of Critical Care Medicine, University of Toronto, 
      Ontario.
FAU - Lapinsky, Stephen E
AU  - Lapinsky SE
FAU - Hallett, David
AU  - Hallett D
FAU - Detsky, Allan S
AU  - Detsky AS
FAU - Sibbald, William J
AU  - Sibbald WJ
FAU - Slutsky, Arthur S
AU  - Slutsky AS
FAU - Stewart, Thomas E
AU  - Stewart TE
CN  - Toronto SARS Critical Care Group
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - JAMA
JT  - JAMA
JID - 7501160
SB  - IM
CIN - JAMA. 2003 Jul 16;290(3):397-9. PMID: 12865383
CIN - ACP J Club. 2004 Jan-Feb;140(1):20. PMID: 14711291
MH  - APACHE
MH  - Adult
MH  - Aged
MH  - Barotrauma/microbiology/therapy
MH  - Communicable Diseases, Emerging
MH  - Comorbidity
MH  - Critical Care
MH  - Disease Outbreaks
MH  - Disease Progression
MH  - Female
MH  - Humans
MH  - Infection Control
MH  - Infectious Disease Transmission, Patient-to-Professional
MH  - *Intensive Care Units
MH  - Lung Diseases, Interstitial/microbiology/therapy
MH  - Male
MH  - Middle Aged
MH  - Multiple Organ Failure/microbiology
MH  - Ontario/epidemiology
MH  - Respiration, Artificial
MH  - Respiratory Distress Syndrome/microbiology/therapy
MH  - Retrospective Studies
MH  - *Severe Acute Respiratory 
      Syndrome/complications/epidemiology/physiopathology/therapy/transmission
MH  - Survival Analysis
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2003/07/17 05:00
MHDA- 2003/07/19 05:00
CRDT- 2003/07/17 05:00
PHST- 2003/07/17 05:00 [pubmed]
PHST- 2003/07/19 05:00 [medline]
PHST- 2003/07/17 05:00 [entrez]
AID - 290/3/367 [pii]
AID - 10.1001/jama.290.3.367 [doi]
PST - ppublish
SO  - JAMA. 2003 Jul 16;290(3):367-73. doi: 10.1001/jama.290.3.367.