This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Viral Infections  • Critical Care/ Intensive Care Medicine  • Adult Critical Care  • Pulmonary Diseases  • Pulmonary Diseases, Other  • Infectious Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Thomas W. K. Lew, MMed, EDIC; Tong-Kiat Kwek, MMed; Dessmon Tai, FRCPE, FCCM; Arul Earnest, MSc; Shi Loo, MMed, EDIC; Kulgit Singh, MMed; Kim Meng Kwan, MMed; Yeow Chan, MMed; Chik Foo Yim, MMed; Siam Lee Bek, MBBS; Ai Ching Kor, MRCP; Wee See Yap, MRCP; Y. Rubuen Chelliah, MMed; Yeow Choy Lai, MMed; Soon-Keng Goh, FRCPE, EDIC

JAMA. 2003;290:374-380.

Context  Severe acute respiratory syndrome (SARS) is an emerging infectious disease with a 25% incidence of progression to acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) and mortality exceeding 10%.

Objective  To describe the clinical spectrum and outcomes of ALI/ARDS in patients with SARS-related critical illness.

Design, Setting, and Patients  Retrospective case series of adult patients with probable SARS admitted to the intensive care unit (ICU) of a hospital in Singapore between March 6 and June 6, 2003.

Main Outcome Measures  The primary outcome measure was 28-day mortality after symptom onset.

Results  Of 199 patients hospitalized with SARS, 46 (23%) were admitted to the ICU, including 45 who fulfilled criteria for ALI/ARDS. Mortality at 28 days for the entire cohort was 20 (10.1%) of 199 and for ICU patients was 17 (37%) of 46. Intensive care unit mortality at 13 weeks was 24 (52.2%) of 46. Nineteen of 24 ICU deaths occurred late (7 days after ICU admission) and were attributed to complications related to severe ARDS, multiorgan failure, thromboembolic complications, or septicemic shock. ARDS was characterized by ease of derecruitment of alveoli and paucity of airway secretion, bronchospasm, or dynamic hyperinflation. Lower Acute Physiology and Chronic Health Evaluation II scores and higher baseline ratios of PaO₂ to fraction of inspired oxygen were associated with earlier recovery.

Conclusions  Critically ill patients with SARS and ALI/ARDS had characteristic clinical findings, high rates of complications; and high mortality. These findings may provide useful information for optimizing supportive care for SARS-related critical illness.

Author Affiliations: Department of Anaesthesiology (Drs Lew, Kwek, Loo, Singh, Kwan, Chan, Bek, Chelliah, and Lai), Medical Intensive Care Unit, Department of General Medicine (Drs Tai and Goh), Clinical Research Unit (Mr Earnest), and Department of Respiratory Medicine (Drs Kor and Yap), Tan Tock Seng Hospital, Singapore; Department of Anaesthesia, Alexandra Hospital, Singapore (Dr Yim).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLES

Critically Ill Patients With Severe Acute Respiratory Syndrome
, , , , , , and
JAMA. ;290():367-373.
FULL TEXT  

Is SARS Just ARDS?

JAMA. ;290():397-399.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Critical Role of IL-17RA in Immunopathology of Influenza Infection
Crowe et al.
J. Immunol. 2009;183:5301-5310.
ABSTRACT | FULL TEXT  

Interferon-Mediated Immunopathological Events Are Associated with Atypical Innate and Adaptive Immune Responses in Patients with Severe Acute Respiratory Syndrome
Cameron et al.
J. Virol. 2007;81:8692-8706.
ABSTRACT | FULL TEXT  

Radiographic-Clinical Correlation in Severe Acute Respiratory Syndrome: Study of 1373 Patients in Hong Kong
Antonio et al.
Radiology 2005;237:1081-1090.
ABSTRACT | FULL TEXT  

Severe Acute Respiratory Syndrome, Pulmonary Function Tests, and Quality of Life: Lessons Learned
Arroliga et al.
Chest 2005;128:1088-1089.
FULL TEXT  

Recombinant Modified Vaccinia Virus Ankara Expressing the Spike Glycoprotein of Severe Acute Respiratory Syndrome Coronavirus Induces Protective Neutralizing Antibodies Primarily Targeting the Receptor Binding Region
Chen et al.
J. Virol. 2005;79:2678-2688.
ABSTRACT | FULL TEXT  

Clinical Issues and Research in Respiratory Failure from Severe Acute Respiratory Syndrome
Levy et al.
Am. J. Respir. Crit. Care Med. 2005;171:518-526.
ABSTRACT | FULL TEXT  

Functional Genomics of Lung Disease
Whitsett et al.
Am. J. Respir. Cell Mol. Bio. 2004;31:S1-S81.
FULL TEXT  

Correlation of High-Resolution CT, Symptoms, and Pulmonary Function in Patients During Recovery From Severe Acute Respiratory Syndrome
Hsu et al.
Chest 2004;126:149-158.
ABSTRACT | FULL TEXT  

T-Cell Epitopes in Severe Acute Respiratory Syndrome (SARS) Coronavirus Spike Protein Elicit a Specific T-Cell Immune Response in Patients Who Recover from SARS
Wang et al.
J. Virol. 2004;78:5612-5618.
ABSTRACT | FULL TEXT  

pH-Dependent Entry of Severe Acute Respiratory Syndrome Coronavirus Is Mediated by the Spike Glycoprotein and Enhanced by Dendritic Cell Transfer through DC-SIGN
Yang et al.
J. Virol. 2004;78:5642-5650.
ABSTRACT | FULL TEXT  

Transmission of Severe Acute Respiratory Syndrome during Intubation and Mechanical Ventilation
Fowler et al.
Am. J. Respir. Crit. Care Med. 2004;169:1198-1202.
ABSTRACT | FULL TEXT  

Prior Infection and Passive Transfer of Neutralizing Antibody Prevent Replication of Severe Acute Respiratory Syndrome Coronavirus in the Respiratory Tract of Mice
Subbarao et al.
J. Virol. 2004;78:3572-3577.
ABSTRACT | FULL TEXT  

ADDITIONAL ARTICLES ABSTRACTED IN ACP JOURNAL CLUB
Evid. Based Med. 2004;9:3-3.
FULL TEXT  

Other articles noted: 25 Jul 03 to 7 Nov 03
Evid. Based Nurs. 2004;7:e1-1.
FULL TEXT  

The Severe Acute Respiratory Syndrome
Peiris et al.
NEJM 2003;349:2431-2441.
FULL TEXT  

Severe acute respiratory syndrome: global initiatives for disease diagnosis
Groneberg et al.
QJM 2003;96:845-852.
ABSTRACT | FULL TEXT  

Is SARS Just ARDS?
Rubenfeld
JAMA 2003;290:397-399.
FULL TEXT