Severe acute respiratory distress syndrome (SARS): a critical care perspective

OBJECTIVE: To review the epidemiology, clinical features, etiology, diagnosis, and management of severe acute respiratory syndrome (SARS) from a critical care perspective. DATA SOURCES: A MEDLINE search was performed using the following terms: severe acute respiratory syndrome and SARS virus. Additional information and references were obtained from the Web sites for the Centers for Disease Control and Prevention, World Health Organization, and Health Canada. STUDY SELECTION: Recent case series were used to develop a review of the epidemiology, clinical features, outcomes, and management of patients with SARS from an intensive care unit (ICU) perspective. This was supplemented by epidemiology information obtained from other Web-based sources. Recent published studies describing the etiology of SARS were also included. DATA SYNTHESIS: SARS has rapidly spread from Southeast Asia to numerous countries, including Canada and the United States. A new coronavirus has been isolated and detected from many affected patients. The mortality rate worldwide is approximately 10.5%. From five cohorts, the ICU admission rate ranged from 20% to 38%. Fifty-nine percent to 100% of the ICU patients required mechanical ventilatory support. The mortality rate of SARS patients admitted to the ICU ranged from 5% to 67%. The most common clinical symptoms and signs are fever, cough, dyspnea, myalgias, malaise, and inspiratory crackles. Common laboratory abnormalities included mild leukopenia, lymphopenia, and increased aspartate transaminase, alanine transaminase, lactic dehydrogenase, and creatine kinase. The chest radiograph pattern ranged from focal infiltrates to diffuse airspace disease. Management consisted of isolation, strict respiratory and contact precautions, ventilatory support as needed, empiric broad-spectrum antibiotics, ribavirin, and corticosteroids. Predictors of mortality included advanced age, the presence of comorbidities, and a high lactic dehydrogenase or high neutrophil count at admission. CONCLUSIONS: SARS is a highly contagious, infectious process that can advance to significant hypoxemic respiratory failure requiring ICU monitoring and support. Early recognition is critical for effective management and containment of this disease.     

Severe acute respiratory syndrome: an overview

Severe acute respiratory syndrome (SARS) is a severe pulmonary infection that has been identified in multiple outbreaks around the world after emerging from mainland China in early 2003. The syndrome is caused by SARS-associated coronavirus, a novel human infection. SARS-associated coronavirus is spread by multiple mechanisms, including direct contact and large-droplet aerosolization, and may be spread by droplet nuclei as well. Clinical disease is characterized by fever, dry cough, interstitial infiltrates, and variable progression to respiratory failure. No treatment has clearly been shown to be effective. Aggressive infection control measures to prevent viral spread are key to outbreak management.     

Severe acute respiratory syndrome: global initiatives for disease diagnosis

We present a retrospective analysis of the available articles on severe acute respiratory syndrome (SARS) published since the outbreak of the disease. SARS is a new infectious disease caused by a novel coronavirus. Originating in Guangdong, Southern China, at the end of 2002, it has spread to regions all over the world, affecting more than 8000 people. With high morbidity and mortality, SARS is an important respiratory disease which may be encountered world-wide. The causative virus was identified by a WHO-led network of laboratories, which identified the genome sequence and developed the first molecular assays for diagnosis. For the respiratory physician, detecting SARS in its earliest stages, identifying pathways of transmission, and implementing preventive and therapeutic strategies are all important. The WHO and the CDC have published helpful definitions of 'suspected' and 'probable' cases. However, the symptoms of the disease may change, and laboratory tests and definitions are still limited. Even in a situation of no new cases of infection, SARS remains a major respiratory health hazard. As with influenza virus outbreaks, new epidemics may arise at the end of each year.     

Palliative care: a challenge for nurses

There is an ever-growing number of cancer patients in the world today. Of the estimated nine million new cancer cases diagnosed in 1997 worldwide, 52% occurred in developing countries (WHO, 1998). The mortality from cancer is expected to rise around the globe. About 7 million deaths per year occur in the world due to cancer, of which, approximately 0.8 million occur in India (WHO, 1994). There is no cure to date for this disease but definitely a lot can be done to make the lives of these people meaningful and productive. With this idea the concept of hospice and palliative care was initiated.     

传染性非典型肺炎

近期流行的传染性非典型肺炎 (非典 )与既往非典相比 ,表现出一些新的特征。此次的传染性非典是由意大利著名传染病专家卡罗·乌尔巴尼首先在越南提出 ,随后世界卫生组织 (WHO)建议称其为“严重急性呼吸道综合征” (SevereAcuteRespiratorySyndrome ,SARS) ,是历年传染性非典中传染性最强、病情较重的一种。从SARS的病原看 ,先后有试验材料及临床表现提示为衣原体、流感病毒、副黏液病毒 ,目前认为是冠状病毒的可能性较大。国内外有关机构正在积极展开多方面研究 ,近期的防治经验表明 ,如能得到及时的支持性治疗和对症治疗 ,绝大多数…     

Bacterial infections: management by acute and critical care nurses

Acute and critical care nurses must maintain a current knowledge base for advancing science and providing direct care for patients. When an infectious process is involved, it is the practicing nurse who must be knowledgeable in treatment and prevention modalities. The integument is the body's first line of defense for invading bacteria. This barrier to bacteria is followed by inflammation and adaptive immunity, the second and third lines of defense against infectious bacteria. It is acute and critical care nurses, however, who should be the first line of defense in preventing the spread of infectious disease. Modern medicine and common sense interventions reviewed in this article are the patient's best defense to good health and wellness when used by nurses.