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SARS - ICU presentation and management

SARS - ICU presentation and management. Dr Gavin Joynt and Dr Florence Yap. 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

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SARS - ICU presentation and management

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  1. SARS - ICU presentation and management Dr Gavin Joynt and Dr Florence Yap

  2. 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. Demographic data 43 ICU admissions from 160 patients 17 Female 26 Male Average age 47 yrs 51 yrs

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

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

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

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

  9. 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

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

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

  12. 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

  13. Enforcement

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

  15. Click here to download “Infection control for SARS” tutorial Click here to quit

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