Clinical issues and research in respiratory failure from severe acute respiratory syndrome.
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.
Levy
Mitchell M
MM
Department of Medicine, Brown University/Rhode Island Hospital, Providence, USA.
Baylor
Melisse S
MS
Bernard
Gordon R
GR
Fowler
Rob
R
Franks
Teri J
TJ
Hayden
Frederick G
FG
Helfand
Rita
R
Lapinsky
Stephen E
SE
Martin
Thomas R
TR
Niederman
Michael S
MS
Rubenfeld
Gordon D
GD
Slutsky
Arthur S
AS
Stewart
Thomas E
TE
Styrt
Barbara A
BA
Thompson
B Taylor
BT
Harabin
Andrea L
AL
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D002170:Canada; D002985:Clinical Protocols / Q000592:standards*; D017714:Community-Acquired Infections / Q000150:complications / Q000517:prevention & control; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000458:organization & administration / Q000592:standards*; D008168:Lung / Q000473:pathology; D011014:Pneumonia / Q000150:complications / Q000517:prevention & control; D015272:Pulmonary Medicine / Q000379:methods / Q000592:standards* / Q000639:trends; D012106:Research / Q000639:trends; D012121:Respiration, Artificial / Q000379:methods; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D045169:Severe Acute Respiratory Syndrome / Q000150:complications / Q000473:pathology / Q000628:therapy*; D014481:United States
D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents