title: Acute respiratory distress syndrome in critically ill patients with severe acute respiratory syndrome.
abstract: BACKGROUND
  Severe acute respiratory syndrome (SARS) is an emerging infectious disease with a 25% incidence of progression to acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) and mortality exceeding 10%.
  
  
  OBJECTIVE
  To describe the clinical spectrum and outcomes of ALI/ARDS in patients with SARS-related critical illness.
  
  
  METHODS
  Retrospective case series of adult patients with probable SARS admitted to the intensive care unit (ICU) of a hospital in Singapore between March 6 and June 6, 2003.
  
  
  METHODS
  The primary outcome measure was 28-day mortality after symptom onset.
  
  
  RESULTS
  Of 199 patients hospitalized with SARS, 46 (23%) were admitted to the ICU, including 45 who fulfilled criteria for ALI/ARDS. Mortality at 28 days for the entire cohort was 20 (10.1%) of 199 and for ICU patients was 17 (37%) of 46. Intensive care unit mortality at 13 weeks was 24 (52.2%) of 46. Nineteen of 24 ICU deaths occurred late (> or =7 days after ICU admission) and were attributed to complications related to severe ARDS, multiorgan failure, thromboembolic complications, or septicemic shock. ARDS was characterized by ease of derecruitment of alveoli and paucity of airway secretion, bronchospasm, or dynamic hyperinflation. Lower Acute Physiology and Chronic Health Evaluation II scores and higher baseline ratios of PaO2 to fraction of inspired oxygen were associated with earlier recovery.
  
  
  CONCLUSIONS
  Critically ill patients with SARS and ALI/ARDS had characteristic clinical findings, high rates of complications; and high mortality. These findings may provide useful information for optimizing supportive care for SARS-related critical illness.
authors.affiliation: Department of Anaesthesiology, Tan Tock Seng Hospital, Singapore. thomas_lew@ttsh.com.sg <thomas_lew@ttsh.com.sg>
authors.forename: Thomas W K
authors.initials: TW
authors.lastname: Lew
authors.forename: Tong-Kiat
authors.initials: TK
authors.lastname: Kwek
authors.forename: Dessmon
authors.initials: D
authors.lastname: Tai
authors.forename: Arul
authors.initials: A
authors.lastname: Earnest
authors.forename: Shi
authors.initials: S
authors.lastname: Loo
authors.forename: Kulgit
authors.initials: K
authors.lastname: Singh
authors.forename: Kim Meng
authors.initials: KM
authors.lastname: Kwan
authors.forename: Yeow
authors.initials: Y
authors.lastname: Chan
authors.forename: Chik Foo
authors.initials: CF
authors.lastname: Yim
authors.forename: Siam Lee
authors.initials: SL
authors.lastname: Bek
authors.forename: Ai Ching
authors.initials: AC
authors.lastname: Kor
authors.forename: Wee See
authors.initials: WS
authors.lastname: Yap
authors.forename: Y Rubuen
authors.initials: YR
authors.lastname: Chelliah
authors.forename: Yeow Choy
authors.initials: YC
authors.lastname: Lai
authors.forename: Soon-Keng
authors.initials: SK
authors.lastname: Goh
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D002423:Cause of Death; D021821:Communicable Diseases, Emerging; D003422:Critical Care; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000382:microbiology; D011175:Positive-Pressure Respiration; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000382:microbiology* / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D045169:Severe Acute Respiratory Syndrome / Q000150:complications* / Q000276:immunology / Q000401:mortality* / Q000628:therapy; D012846:Singapore / Q000453:epidemiology; D016019:Survival Analysis