title: Critically ill patients with severe acute respiratory syndrome.
abstract: BACKGROUND
  Severe acute respiratory syndrome (SARS) is a newly recognized infectious disease capable of causing severe respiratory failure.
  
  
  OBJECTIVE
  To determine the epidemiological features, course, and outcomes of patients with SARS-related critical illness.
  
  
  METHODS
  Retrospective case series of 38 adult patients with SARS-related critical illness admitted to 13 intensive care units (ICUs) in the Toronto area between the onset of the outbreak and April 15, 2003. Data were collected daily during the first 7 days in the ICUs, and patients were followed up for 28 days.
  
  
  METHODS
  The primary outcome was mortality at 28 days after ICU admission. Secondary outcomes included rate of SARS-related critical illness, number of tertiary care ICUs and staff placed under quarantine, and number of health care workers (HCWs) contracting SARS secondary to ICU-acquired transmission.
  
  
  RESULTS
  Of 196 patients with SARS, 38 (19%) became critically ill, 7 (18%) of whom were HCWs. The median (interquartile range [IQR]) age of the 38 patients was 57.4 (39.0-69.6) years. The median (IQR) duration between initial symptoms and admission to the ICU was 8 (5-10) days. Twenty-nine (76%) required mechanical ventilation and 10 of these (34%) experienced barotrauma. Mortality at 28 days was 13 (34%) of 38 patients and for those requiring mechanical ventilation, mortality was 13 (45%) of 29. Six patients (16%) remained mechanically ventilated at 28 days. Two of these patients had died by 8 weeks' follow-up. Patients who died were more often older, had preexisting diabetes mellitus, and on admission to hospital were more likely to have bilateral radiographic infiltrates. Transmission of SARS in 6 study ICUs led to closure of 73 medical-surgical ICU beds. In 2 university ICUs, 164 HCWs were quarantined and 16 (10%) developed SARS.
  
  
  CONCLUSIONS
  Critical illness was common among patients with SARS. Affected patients had primarily single-organ respiratory failure, and half of mechanically ventilated patients died. The SARS outbreak greatly strained regional critical care resources.
authors.affiliation: Interdepartmental Division of Critical Care Medicine, University of Toronto, Ontario.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fowler
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Lapinsky
authors.forename: David
authors.initials: D
authors.lastname: Hallett
authors.forename: Allan S
authors.initials: AS
authors.lastname: Detsky
authors.forename: William J
authors.initials: WJ
authors.lastname: Sibbald
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Slutsky
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Stewart
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D001469:Barotrauma / Q000382:microbiology / Q000628:therapy; D021821:Communicable Diseases, Emerging; D015897:Comorbidity; D003422:Critical Care; D004196:Disease Outbreaks; D018450:Disease Progression; D005260:Female; D006801:Humans; D017053:Infection Control; D017758:Infectious Disease Transmission, Patient-to-Professional; D007362:Intensive Care Units; D017563:Lung Diseases, Interstitial / Q000382:microbiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000382:microbiology; D009864:Ontario / Q000453:epidemiology; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000382:microbiology / Q000628:therapy; D012189:Retrospective Studies; D045169:Severe Acute Respiratory Syndrome / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy / Q000635:transmission; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome