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Review
. 2003 Nov;8 Suppl(Suppl 1):S31-5.
doi: 10.1046/j.1440-1843.2003.00521.x.

SARS: ventilatory and intensive care

Loretta Y C Yam  1 , Rong Chang Chen, Nan Shan Zhong
Affiliations
Review

SARS: ventilatory and intensive care

Loretta Y C Yam et al. Respirology. 2003 Nov.

Abstract

Severe acute respiratory syndrome (SARS) is an emerging infection caused by a novel coronavirus. It is characterised by a highly infectious syndrome of fever and respiratory symptoms, and is usually associated with bilateral lung infiltrates. The clinical syndrome of SARS often progresses to varying degrees of respiratory failure, with about 20% of patients requiring intensive care. Despite concern about potential aerosol generation, non-invasive ventilation (NIV) has been reported to be efficacious in the treatment of SARS-related ARF without posing infection risks to health care workers (HCW). Spontaneous pneumomediastinum and pneumothorax in SARS is common. The incidence of NIV-associated barotrauma ranged from 6.6% to 15%. Patients who fail to tolerate NIV or fail NIV with progressive dyspnoea, tachypnoea and hypoxaemia should be intubated and mechanically ventilated. Mortality rates in intensive care units for SARS patients were high: 34-53% at 28 days, when some patients were still being ventilated. Strict adherence to infection control measures including isolation, use of appropriate personal protective equipment and negative pressure environment had been reported to eliminate cross-infection to HCW.

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Figures

Figure 1
Figure 1
Powered air purifying respirator (PAPR) (Air‐mate). (a) Frontal view. (b) Back view of battery with HEPA filter and duct supplying purified air to hood unit.
Figure 2
Figure 2
(a) Closed circuit (in‐line) suction system with heat and moisture exchanger (HME) shown as white flexitube connected to a viral/bacterial filter. (b) Servo‐Evac 180 for connection to exhalation port of ventilator. The Servo‐Evac 180 consists of a connection to the ventilator's expiratory port (curved flexitube) which empties expired air into a Evac Bag, which has a one‐way valve through which expired gas can be removed via an evacuation hose (white tube) connected to a suction source. The straight flexitube is open to the atmosphere to ensure the patient is not subjected to undue negative pressure or excessive resistance in case the suction sources is interrupted.
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