Critically ill patients with severe acute respiratory syndrome
Critically ill patients with severe acute respiratory syndrome
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DOI：
10.1001/jama.290.3.367
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发表时间：
2003-07-16
影响因子：
120.7
通讯作者：
Stewart, TE
中科院分区：
文献类型：
--
作者：
Fowler, RA;Lapinsky, SE;Stewart, TE
背景严重急性呼吸综合征(SARS)是一种新发现的可导致严重呼吸衰竭的传染病。目的了解SARS相关危重患者的流行病学特征、病程和转归。设计、设置和患者回顾2003年4月15日至2003年4月15日期间在多伦多地区13个重症监护室(ICU)收治的38例SARS相关危重患者的病例序列。在ICU的前7天每天收集数据，并对患者进行28天的随访。主要结果指标是入院后28天的死亡率。结果196例SARS患者中，38例(19%)危重，其中7例(18%)为重症患者。38例患者的中位年龄(四分位数范围[IQR])为57.4(39.0-69.6)岁。从最初症状到进入ICU的中位时间(IQR)为8(5-10)天。29例(76%)需要机械通气，其中10例(34%)经历了气压创伤。38例患者中，28天的死亡率为13例(34%)，而那些需要机械通气的患者中，29例中的死亡率为13例(45%)。6名患者(16%)在28天后仍保持机械通气。其中两名患者在随访8周时死亡。死亡的患者往往年龄较大，有既往糖尿病。在入院时，更有可能有双侧放射学浸润性病变。SARS在6个研究ICU中的传播导致73个内外科ICU床位关闭。在2所高校ICU中，共隔离医务人员164人，发生SARS 16人(10%)。结论SARS患者中危重疾病较常见。受影响的患者主要是单器官呼吸衰竭，一半的机械通气患者死亡。非典疫情极大地加剧了区域重症监护资源的紧张。
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 alter 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.