SARS - ICU presentation and management

© Gavin Joynt & Florence Yap April 2003

SARS - ICU presentation and management

Dr Gavin Joynt and Dr Florence Yap


DisclaimerSARS is a new disease and our concepts of how it should bemanaged will be continuously evolving.

Please note that the following lecture reflects the experience of the Management team of the Prince of Wales Hospital Intensive Care Unit. While every effort has been made to provide factual and correct information, many observations are empirical.

The authors, the Prince of Wales Hospital and The Chinese University of Hong Kong accept no responsibility for any adverse event or liability that may arise as a result of the use of this presentation.


Demographic data43 ICU admissions from 160 patients

17 Female 26 Male

Average age47 yrs 51 yrs


Presentation• Criteria for admission

• SaO2 < 90% with FiO2 > 0.5• RR > 35 breaths/min

• Clinical features on admission• Hypoxia/Tachypnoea

• Severity of illness (no. of organ failures)• Isolated respiratory failure


Management• Respiratory support

• Oxygen therapy– NO Nebulization– NO Venturi-type masks– Nasal cannulae, Hudson mask and non-rebreathing

mask• Positive pressure ventilation

– NO Non-invasive ventilation– Humidification and circuit protection– Low volume/pressure ventilation– Prone ventilation (variable response)


Management• Medical management

• Ribavirin– Oral/IV

• Steroid – Maintenance– Pulse– Rebound

• Empirical broad-spectrum antibiotics– Type– Duration

• Convalescent serum






General Management• Fluid balance• Haematology and Biochemistry

– Neutrophil/Lymphocyte count– Platelet count– LDH– CPK– ALT– CRP


Complications• Nosocomial sepsis

– Rate– Organisms

• Biochemistry and fluid balance• Hypernatremia

• Barotrauma• Three cases

• Diarrhoea• Infection Control issue!


Clinical course• Based on partial cohort outcome (19 in ICU, 13

vent.)– Ventilation rate (Approx 60%)

• Prone (7 patients, of whom 1 discharged)– Discharges (Ave age 35 yrs)

• Male 11/26 (42%)• Female 8/17 (47 %)

– Deaths (Ave age 66 yrs)• Male 5 (12%+)• Co-morbidity (2 hepatic, 2 hematological, 1 CVS)

• Apparent clinical response to ribavirin and steriod combinations



Infection Control– Cap– Mask (N95 as a minimum) Fit Tested– Visor– Gown– Gloves– Shoe-covers


Infection Control• Respiratory

•No Nebulizer•No Venturi-type mask•No BiPAP

– Ventilated patients• Closed circuit suction• High quality bacterial/viral filters• Expired gas scavenging


Infection control

• Plastic cover• Pagers and inanimate objects

• Pens left in the ICU• Note-paper is left in the ICU - consider

faxing copies to your office, if necessary





Management Issues• Staff updates daily

• Bed status• Staff health• Infection control • Psychological• Contact numbers



Click here to download “Infection control for SARS” tutorial

Click here to quit

http://www.aic.cuhk.edu.hk/web8/download.htm

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SARS - ICU presentation and management