Critical care lessons from severe acute respiratory syndrome.
Critical care lessons from severe acute respiratory syndrome.
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DOI：
10.1097/00075198-200402000-00009
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发表时间：
2004-02-01
影响因子：
3.3
通讯作者：
Granton, John T
中科院分区：
文献类型：
--
作者：
Lapinsky, Stephen E;Granton, John T
审查目的：严重急性呼吸道综合症（SARS）是一种新疾病，2003年上半年在多个国家大面积暴发，导致8000多人感染，900多人死亡。在此期间，大量文献迅速涌现，描述了临床疾病、病原病毒因子和治疗方案。本文回顾了该知识库的现状，特别是危重患者。最近的发现：来自香港、中国、新加坡和多伦多的病例系列对该疾病的特征具有显着的一致性。多伦多和新加坡的研究也得出了同样一致的关于患有呼吸衰竭的 SARS 患者的情况。全球合作促进了病原病毒 SARS-CoV 的快速鉴定和基因测序。 摘要：SARS 是一种主要的呼吸道疾病，通过呼吸道分泌物的飞沫传播，也可能通过粪口途径传播。少数“超级传播者”似乎导致了疾病的迅速扩散。感染控制预防措施是管理的重要组成部分。约20%的患者出现进行性肺部浸润和呼吸衰竭，死亡率高达10%。利巴韦林等抗病毒药物的治疗策略尚未明确显示其益处，但高剂量皮质类固醇似乎对病情进展的患者有益。最近的疫情爆发凸显了这种疾病可能会导致重症监护资源不堪重负，包括患者数量以及医护人员因病和隔离而流失的情况。
PURPOSE OF REVIEW: Severe acute respiratory syndrome (SARS) is a new disease that caused large outbreaks in several countries in the first half of 2003, resulting in infection in more than 8000 people and more than 900 deaths. During that time, a large body of literature rapidly emerged describing the clinical disease, the etiologic viral agent, and management options. This paper reviews the current status of this knowledge base, with particular reference to the critically ill patient.RECENT FINDINGS: Case series of patients from Hong Kong, China, Singapore, and Toronto have characterized the disease with remarkable uniformity. A similarly consistent picture of the SARS patient with respiratory failure has emerged from studies from Toronto and Singapore. Worldwide collaboration led to the rapid identification and gene sequencing of the etiologic virus, SARS-CoV.SUMMARY: SARS is a predominantly respiratory illness, spread through droplets from respiratory secretions and possibly via a fecal-oral route. A small number of "super-spreaders" appear to have contributed to the rapid proliferation of the disease. Infection control precautions are an essential component of management. Approximately 20% of patients develop progressive pulmonary infiltrates and respiratory failure, and the mortality rate is as high as 10%. Treatment strategies with antiviral agents such as ribavirin have not clearly demonstrated a benefit, but high-dose corticosteroids appear to be beneficial in patients with progressive disease. The recent outbreaks highlighted the potential for this disease to overwhelm critical care resources, by the volume of patients and loss of healthcare workers to illness and quarantine.