title: Acute Management and Long-Term Survival Among Subjects With Severe Middle East Respiratory Syndrome Coronavirus Pneumonia and ARDS.
abstract: BACKGROUND
  Data on the management, clinical course, and outcome of critical patients with Middle East Respiratory Syndrome coronavirus are scarce. We report here our experience and long-term outcome of such patients.
  
  
  METHODS
  Subjects intubated for management of ARDS from Middle East Respiratory Syndrome coronavirus pneumonia and ARDS during the April-May 2014 outbreak were included. Their characteristics, ICU course, management, and outcome were evaluated.
  
  
  RESULTS
  Fourteen subjects, including 3 health-care workers, met study criteria. Besides 2 health-care workers, all subjects had comorbidities. Predominant symptoms were fever, cough, and dyspnea. The worst median PaO2 /FIO2 ratio of 118 post-intubation was seen on the third day, and median APACHE II score was 27. All subjects received lung-protective ventilation and 1 mg/kg/d methylprednisolone infusion for ARDS. Eleven subjects received ribavirin and peginterferon α-2a. Subjects had a critical ICU course and required neuromuscular blockade (n = 11; 79%), required rescue therapy for respiratory failure (n = 8; 57%), developed shock (n = 10; 71%), and required renal replacement therapy (n = 8; 57%). Declining C-reactive protein levels correlated with clinical improvement despite continued positive real-time polymerase chain reaction results. Nine subjects died in ICU. Five subjects, including 3 health-care workers, were discharged from hospital and were alive after 1 y.
  
  
  CONCLUSIONS
  Middle East Respiratory Syndrome coronavirus pneumonia with ARDS has high mortality in subjects with comorbidities. The mainstay of treatment is meticulous ARDS management. Those who survived the acute infection and its complications remained well after 1 y in our study. The role of ribavirin and interferon warrants urgent further evaluation.
authors.affiliation: King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia. John D Dingell Veterans Affairs Medical Center, Detroit, Michigan. dr.imrankhalid@yahoo.com.
authors.forename: Imran
authors.initials: I
authors.lastname: Khalid
authors.affiliation: King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
authors.forename: Basem M
authors.initials: BM
authors.lastname: Alraddadi
authors.affiliation: King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
authors.forename: Youssef
authors.initials: Y
authors.lastname: Dairi
authors.affiliation: King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
authors.forename: Tabindeh J
authors.initials: TJ
authors.lastname: Khalid
authors.affiliation: King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
authors.forename: Mazen
authors.initials: M
authors.lastname: Kadri
authors.affiliation: King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
authors.forename: Abeer N
authors.initials: AN
authors.lastname: Alshukairi
authors.affiliation: King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
authors.forename: Ismael A
authors.initials: IA
authors.lastname: Qushmaq
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D002097:C-Reactive Protein; D018352:Coronavirus Infections / Q000401:mortality / Q000628:therapy* / Q000821:virology; D004196:Disease Outbreaks; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D065207:Middle East Respiratory Syndrome Coronavirus; D011024:Pneumonia, Viral / Q000401:mortality / Q000628:therapy* / Q000821:virology; D060888:Real-Time Polymerase Chain Reaction; D012121:Respiration, Artificial / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy* / Q000821:virology; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy* / Q000821:virology; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D002097:C-Reactive Protein
keywords: Middle East Respiratory Syndrome coronavirus; acute respiratory distress syndrome (ARDS); pneumonia; respiratory failure