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Critically Ill Patients With Severe Acute Respiratory Syndrome
Robert A. Fowler, MD, MS;
Stephen E. Lapinsky, MB, BCh, MSc;
David Hallett, MSc;
Allan S. Detsky, MD, PhD;
William J. Sibbald, MD;
Arthur S. Slutsky, MD;
Thomas E. Stewart, MD; for the Toronto SARS Critical Care Group
JAMA. 2003;290:367-373.
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.
Author Affiliations: Interdepartmental Division of Critical Care Medicine (Drs Fowler, Lapinsky, Sibbald, Slutsky, and Stewart) and Departments of Medicine (Drs Fowler, Lapinsky, Detsky, Sibbald, Slutsky, and Stewart), Health Policy, Management, and Evaluation (Dr Detsky), and Anaesthesia (Dr Stewart), University of Toronto; Sunnybrook and Women's College Health Sciences Centre (Drs Fowler and Sibbald); Mount Sinai Hospital (Drs Lapinsky, Detsky, and Stewart and Mr Hallett); St Michaels Hospital (Dr Slutsky); and University Health Network (Drs Detsky and Stewart), Toronto, Ontario.
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