SARS ICU presentation and management

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SARS - ICU presentation and management
Dr Gavin Joynt and Dr Florence Yap
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Disclaimer
SARS is a new disease and our concepts of how it
should be managed will be continuously evolving.
Please note that the following lecture reflects
the experience of the Management team of the
Prince of Wales Hospital Intensive Care Unit.
While every effort has been made to provide
factual and correct information, many
observations are empirical. The authors, the
Prince of Wales Hospital and The Chinese
University of Hong Kong accept no responsibility
for any adverse event or liability that may
arise as a result of the use of this
presentation.
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Demographic data

• 43 ICU admissions from 160 patients
• 17 Female 26 Male
• Average age
• 47 yrs 51 yrs

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Presentation

• Criteria for admission
• SaO2 lt 90 with FiO2 gt 0.5
• RR gt 35 breaths/min
• Clinical features on admission
• Hypoxia/Tachypnoea
• Severity of illness (no. of organ failures)
• Isolated respiratory failure

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Management

• Respiratory support
• Oxygen therapy
• NO Nebulization
• NO Venturi-type masks
• Nasal cannulae, Hudson mask and non-rebreathing
  mask
• Positive pressure ventilation
• NO Non-invasive ventilation
• Humidification and circuit protection
• Low volume/pressure ventilation
• Prone ventilation (variable response)

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Management

• Medical management
• Ribavirin
• Oral/IV
• Steroid
• Maintenance
• Pulse
• Rebound
• Empirical broad-spectrum antibiotics
• Type
• Duration
• Convalescent serum

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General Management

• Fluid balance
• Haematology and Biochemistry
• Neutrophil/Lymphocyte count
• Platelet count
• LDH
• CPK
• ALT
• CRP

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Complications

• Nosocomial sepsis
• Rate
• Organisms
• Biochemistry and fluid balance
• Hypernatremia
• Barotrauma
• Three cases
• Diarrhoea
• Infection Control issue!

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Clinical course

• Based on partial cohort outcome (19 in ICU, 13
  vent.)
• Ventilation rate (Approx 60)
• Prone (7 patients, of whom 1 discharged)
• Discharges (Ave age 35 yrs)
• Male 11/26 (42)
• Female 8/17 (47 )
• Deaths (Ave age 66 yrs)
• Male 5 (12)
• Co-morbidity (2 hepatic, 2 hematological, 1 CVS)
• Apparent clinical response to ribavirin and
  steriod combinations

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Infection Control

• Cap
• Mask (N95 as a minimum) Fit Tested
• Visor
• Gown
• Gloves
• Shoe-covers

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Infection Control

• Respiratory
• No Nebulizer
• No Venturi-type mask
• No BiPAP
• Ventilated patients
• Closed circuit suction
• High quality bacterial/viral filters
• Expired gas scavenging

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Infection control

• Plastic cover
• Pagers and inanimate objects
• Pens left in the ICU
• Note-paper is left in the ICU - consider faxing
  copies to your office, if necessary

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Enforcement
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Management Issues

• Staff updates daily
• Bed status
• Staff health
• Infection control
• Psychological
• Contact numbers

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