Severe acute respiratory distress syndrome (SARS): A critical care perspective
Severe acute respiratory distress syndrome (SARS): A critical care perspective
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DOI：
10.1097/01.ccm.0000091929.51288.5f
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发表时间：
2003-11-01
影响因子：
8.8
通讯作者：
Russell, JA
中科院分区：
文献类型：
--
作者：
Manocha, S;Walley, KR;Russell, JA
目的：从危重病护理的角度回顾严重急性呼吸综合征（SARS）的流行病学、临床特征、病原学、诊断和管理。数据来源：使用以下术语进行MEDLINE检索：严重急性呼吸综合征和SARS病毒。其他信息和参考资料来自疾病控制和预防中心、世界卫生组织和加拿大卫生部的网站。最近的病例系列被用来发展的流行病学，临床特征，结果，并从重症监护病房（ICU）的角度与SARS患者的管理审查。从其他网络来源获得的流行病学信息对这一点进行了补充。资料综合：SARS已从东南亚迅速蔓延到包括加拿大和美国在内的许多国家。从多名受感染患者身上分离并检测出新型冠状病毒。全世界的死亡率约为10.5%。从5个队列中，ICU入院率范围为20%至38%。59%至100%的ICU患者需要机械辅助支持。重症监护室的SARS患者死亡率从5%到67%不等。最常见的临床症状和体征是发热、咳嗽、呼吸困难、肌痛、不适和吸气性湿罗音。常见的实验室检查异常包括轻度白细胞减少症、淋巴细胞减少症和天冬氨酸转氨酶、丙氨酸转氨酶、乳酸脱氢酶和肌酸激酶升高。胸片表现为局灶性浸润至弥漫性气腔病变。管理包括隔离，严格的呼吸和接触预防措施，必要时的辅助治疗，经验性广谱抗生素，利巴韦林和皮质类固醇。死亡率的预测因素包括高龄、合并症、入院时乳酸脱氢酶升高或中性粒细胞计数升高。SARS是一种高度传染性的传染过程，可发展为严重的低氧性呼吸衰竭，需要ICU监测和支持。早期识别对于有效管理和遏制这一疾病至关重要。
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.