sars - icu presentation and management
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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 - PowerPoint PPT PresentationTRANSCRIPT
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© Gavin Joynt & Florence Yap April 2003
SARS - ICU presentation and management
Dr Gavin Joynt and Dr Florence Yap
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© Gavin Joynt & Florence Yap April 2003
DisclaimerSARS is a new disease and our concepts of how it should bemanaged 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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© Gavin Joynt & Florence Yap April 2003
Demographic data43 ICU admissions from 160 patients
17 Female 26 Male
Average age47 yrs 51 yrs
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© Gavin Joynt & Florence Yap April 2003
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
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© 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)
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© Gavin Joynt & Florence Yap April 2003
Management• Medical management
• Ribavirin– Oral/IV
• Steroid – Maintenance– Pulse– Rebound
• Empirical broad-spectrum antibiotics– Type– Duration
• Convalescent serum
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© Gavin Joynt & Florence Yap April 2003
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© Gavin Joynt & Florence Yap April 2003
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© Gavin Joynt & Florence Yap April 2003
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© Gavin Joynt & Florence Yap April 2003
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© Gavin Joynt & Florence Yap April 2003
General Management• Fluid balance• Haematology and Biochemistry
– Neutrophil/Lymphocyte count– Platelet count– LDH– CPK– ALT– CRP
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© Gavin Joynt & Florence Yap April 2003
Complications• Nosocomial sepsis
– Rate– Organisms
• Biochemistry and fluid balance• Hypernatremia
• Barotrauma• Three cases
• Diarrhoea• Infection Control issue!
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© 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
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© Gavin Joynt & Florence Yap April 2003
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© Gavin Joynt & Florence Yap April 2003
Infection Control– Cap– Mask (N95 as a minimum) Fit Tested– Visor– Gown– Gloves– Shoe-covers
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© 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
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© 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
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© Gavin Joynt & Florence Yap April 2003
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© Gavin Joynt & Florence Yap April 2003
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© Gavin Joynt & Florence Yap April 2003
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© Gavin Joynt & Florence Yap April 2003
Management Issues• Staff updates daily
• Bed status• Staff health• Infection control • Psychological• Contact numbers
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© Gavin Joynt & Florence Yap April 2003
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© Gavin Joynt & Florence Yap April 2003
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