Context Severe acute respiratory syndrome (SARS) is an emerging infectious disease
with a 25% incidence of progression to acute lung injury (ALI)/acute respiratory
distress syndrome (ARDS) and mortality exceeding 10%.
Objective To describe the clinical spectrum and outcomes of ALI/ARDS in patients
with SARS-related critical illness.
Design, Setting, and Patients Retrospective case series of adult patients with probable SARS admitted
to the intensive care unit (ICU) of a hospital in Singapore between March
6 and June 6, 2003.
Main Outcome Measures The primary outcome measure was 28-day mortality after symptom onset.
Results Of 199 patients hospitalized with SARS, 46 (23%) were admitted to the
ICU, including 45 who fulfilled criteria for ALI/ARDS. Mortality at 28 days
for the entire cohort was 20 (10.1%) of 199 and for ICU patients was 17 (37%)
of 46. Intensive care unit mortality at 13 weeks was 24 (52.2%) of 46. Nineteen
of 24 ICU deaths occurred late (≥7 days after ICU admission) and were attributed
to complications related to severe ARDS, multiorgan failure, thromboembolic
complications, or septicemic shock. ARDS was characterized by ease of derecruitment
of alveoli and paucity of airway secretion, bronchospasm, or dynamic hyperinflation.
Lower Acute Physiology and Chronic Health Evaluation II scores and higher
baseline ratios of PaO2 to fraction of inspired oxygen were associated
with earlier recovery.
Conclusions Critically ill patients with SARS and ALI/ARDS had characteristic clinical
findings, high rates of complications; and high mortality. These findings
may provide useful information for optimizing supportive care for SARS-related