1. © Gavin Joynt & Florence Yap April 2003 SARS - ICU presentation and management Dr Gavin Joynt and Dr Florence Yap

2. © Gavin Joynt & Florence Yap April 2003 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.

3. © Gavin Joynt & Florence Yap April 2003 Demographic data 43 ICU admissions from 160 patients 17 Female 26 Male Average age 47 yrs 51 yrs

4. © Gavin Joynt & Florence Yap April 2003 Presentation Criteria for admission SaO2 0.5 RR > 35 breaths/min Clinical features on admission Hypoxia/Tachypnoea Severity of illness (no. of organ failures) Isolated respiratory failure

5. © Gavin Joynt & Florence Yap April 2003 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)

6. © Gavin Joynt & Florence Yap April 2003 Management Medical management Ribavirin –Oral/IV Steroid –Maintenance –Pulse –Rebound Empirical broad-spectrum antibiotics –Type –Duration Convalescent serum

7. © Gavin Joynt & Florence Yap April 2003

11. General Management Fluid balance Haematology and Biochemistry –Neutrophil/Lymphocyte count –Platelet count –LDH –CPK –ALT –CRP

12. © Gavin Joynt & Florence Yap April 2003 Complications Nosocomial sepsis –Rate –Organisms Biochemistry and fluid balance Hypernatremia Barotrauma Three cases Diarrhoea Infection Control issue!

13. © Gavin Joynt & Florence Yap April 2003 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

14. © Gavin Joynt & Florence Yap April 2003

15. Infection Control –Cap –Mask (N95 as a minimum) Fit Tested –Visor –Gown –Gloves –Shoe-covers

16. © Gavin Joynt & Florence Yap April 2003 Infection Control Respiratory No Nebulizer No Venturi-type mask No BiPAP –Ventilated patients Closed circuit suction High quality bacterial/viral filters Expired gas scavenging

17. © Gavin Joynt & Florence Yap April 2003 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

18. © Gavin Joynt & Florence Yap April 2003

21. Management Issues Staff updates daily Bed status Staff health Infection control Psychological Contact numbers

22. © Gavin Joynt & Florence Yap April 2003

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