Mechanical ventilation in an airborne epidemic.
With the increasing threat of pandemic influenza and catastrophic bioterrorism, it is important for intensive care providers to be prepared to meet the challenge of large-scale airborne epidemics causing mass casualty respiratory failure. The severe acute respiratory syndrome outbreak exposed the vulnerability of health care workers and highlighted the importance of establishing stringent infection control and crisis management protocols. Patients who have acute lung injury and acute respiratory distress syndrome who require mechanical ventilation should receive a lung protective, low tidal volume strategy. Controversy remains regarding the use of high-frequency oscillatory ventilation and noninvasive positive pressure ventilation. Standard, contact, and airborne precautions should be instituted in intensive care units, with special care taken when aerosol-generating procedures are performed.
Phua
Ghee-Chee
GC
Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Outram Road, Singapore 169608. phua.gee.chee@sgh.com.sg
Govert
Joseph
J
D000391:Air Microbiology; D003422:Critical Care / Q000379:methods; D004196:Disease Outbreaks; D006801:Humans; D017053:Infection Control / Q000379:methods*; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control; D012121:Respiration, Artificial / Q000379:methods*; D045169:Severe Acute Respiratory Syndrome / Q000628:therapy*