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Guideline
. 2005 Mar 1;171(5):518-26.
doi: 10.1164/rccm.200405-621WS. Epub 2004 Dec 10.

Clinical issues and research in respiratory failure from severe acute respiratory syndrome

Mitchell M Levy  1 , Melisse S Baylor, Gordon R Bernard, Rob Fowler, Teri J Franks, Frederick G Hayden, Rita Helfand, Stephen E Lapinsky, Thomas R Martin, Michael S Niederman, Gordon D Rubenfeld, Arthur S Slutsky, Thomas E Stewart, Barbara A Styrt, B Taylor Thompson, Andrea L Harabin; National Heart, Lung, and Blood Institute; Centers for Disease Control and Prevention; Institute of Allergy and Infectious Diseases
Affiliations
Guideline

Clinical issues and research in respiratory failure from severe acute respiratory syndrome

Mitchell M Levy et al. Am J Respir Crit Care Med. .

Abstract

The National Heart, Lung, and Blood Institute, along with the Centers for Disease Control and Prevention and the National Institute of Allergy and Infectious Diseases, convened a panel to develop recommendations for treatment, prevention, and research for respiratory failure from severe acute respiratory syndrome (SARS) and other newly emerging infections. The clinical and pathological features of acute lung injury (ALI) from SARS appear indistinguishable from ALI from other causes. The mainstay of treatments for ALI remains supportive. Patients with ALI from SARS who require mechanical ventilation should receive a lung protective, low tidal volume strategy. Adjuvant treatments recommended include prevention of venous thromboembolism, stress ulcer prophylaxis, and semirecumbent positioning during ventilation. Based on previous experience in Canada, infection control resources and protocols were recommended. Leadership structure, communication, training, and morale are an essential aspect of SARS management. A multicenter, placebo-controlled trial of corticosteroids for late SARS is justified because of widespread clinical use and uncertainties about relative risks and benefits. Studies of combined pathophysiologic endpoints were recommended, with mortality as a secondary endpoint. The group recommended preparation for studies, including protocols, ethical considerations, Web-based registries, and data entry systems.

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