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  SARS - Severe Acute Respiratory Syndrome
 
 

 

 What is SARS?

  • A rare form of pneumonia that is resistant to antibiotics and antiviral medication

  • Believed to have started in the southern Chinese province of Guangdong

 What are SARS symptoms?

  • Fever of more than 100.4 F

  • Dry cough

  • Shortness of breath

  • Hypoxia (low blood oxygen level)

  • Difficulty breathing

  • Pneumonia

  • Abnormal X-ray

  • Acute Respiratory Distress Syndrome (lung inflammation that prevents normal function)

 Who is at risk for contracting SARS?

  • Someone who has traveled to mainland China, Hong Kong, Singapore, Toronto or Hanoi, Vietnam, in the past 10 days.

  • Someone who has had close contact with someone who has traveled to an affected area.

  • Someone who has had close contact with a known SARS patient.

 To prevent secondary  transmission of SARS,  an exposed person should:

  • Avoid contact with others

  • Seek immediate medical attention

  • Practice infection-control precautions (careful hand washing, use of disposable gloves and surgical masks)

 

 

 

 

 

 

 

 

 

 
 

May 9, 2003

The role of the anesthesiologists in treating SARS symptoms

One of the many roles of the anesthesiologist is to treat patients in respiratory distress. With the recent outbreak of the atypical pneumonia SARS (severe acute respiratory syndrome), anesthesiologists with critical care training play a unique role in treating one specific life-threatening symptom associated with SARS called ARDS (acute respiratory distress syndrome).

ARDS is a medical condition in which the lungs are unable to function properly due to inflammation. This then leads to fluid leaking into the lungs, preventing the normal breathing process from taking place. Initially SARS symptoms include a fever of more than 100.4 F accompanied by a dry cough and/or difficulty breathing. A few SARS patients, however, have developed ARDS, requiring mechanical ventilation.

Anesthesiologists with critical care training are even better situated to manage patients with ARDS because they are as familiar as any ICU physician and sometimes more familiar with the special modes of mechanical ventilation that can be used to manage patients with ARDS. This is because in their traditional role in the operating room; anesthesiologists are responsible for the patient's breathing.

Anesthesiologists in the ICU help patients recover from ARDS by using a mechanical ventilator to help oxygenate and ventilate the patient. Sometimes this requires sedating patients into a drug-induced coma so that they aren't too anxious and "fight" the ventilator.

The typical mortality rate quoted for patients with ARDS is somewhere between 20% and 45%. Trauma patients, who tend to be younger and without other medical conditions, are usually at the lower end of the scale, i.e., 20% range. Elderly patients with medical problems such as pneumonia or SARS are more likely to develop severe problems.

Because SARS is contagious, the Centers for Disease Control and Prevention (CDC) recommend that "patients with the illness receive the same treatment that would be used for any patient with serious community acquired pneumonia of an unknown cause." Once admitted to the hospital, SARS patients are isolated, and health officials are directed to follow strict infection control policies to limit the exposure of the disease within the facility.

Currently SARS is thought to be spread by droplets produced when an infected person coughs or sneezes, but the exact method of transmission is still being studied.

Supportive care and respiratory therapy are also being used to treat SARS patients. Supportive care does not treat the disease, but supplies the basic nutrients without inducing further injury while the body's own processes repair the damage.

For example, if a patient is receiving respiratory therapy for SARS and the illness is relatively "mild," the patient would probably just receive supplemental oxygen and chest physical therapy to help them clear their secretions. If their blood's oxygen levels continued to deteriorate, along with a worsening x-ray, they might require endotracheal intubation and mechanical ventilation. Supportive care would then include artificial feeding for the patient.

A cure for SARS has not been determined, and health officials are busy working on a vaccine. It is estimated that a vaccine will take a year to be developed. Tests are also being developed to diagnose the virus. In the meantime, to avoid contracting SARS, the CDC recommends postponing nonessential trips to mainland China, Hong Kong, Singapore, Toronto and Hanoi, Vietnam.

According to a CDC report including SARS cases reported in the United States, only 35 out of 208 suspected cases (17%) had illness consistent with the World Health Organization (WHO) definition of probable SARS cases. The SARS cases reported in the U.S. are considered limited local transmission by WHO. This means that the illness was transmitted only by close person-to-person contact (having cared for, lived with or having direct contact with respiratory secretions and/or body fluids) with known SARS patients.

For more information on SARS, go to:

Acknowledgement:
ASA Committee on Critical Care Medicine and Trauma Medicine (Michael Murray, M.D., chair)

Resources:
Beil, Laura. "CDC focusing on new strain of germ as cause of SARS"; The Dallas Morning News; 3 April 2003.

"Bush issues SARS executive order" MSNBC.com; 7 April 2003.

Centers for Disease Control and Prevention; http://www.cdc.gov/ncidod/sars/faq.htm

Gottlieb, Jeff. "Orange county; 2 more in county show signs of SARS"; Los Angeles Times; 4 April 2003.

Williams, Beverly N., "Rumors, fears fly as SARS spreads"; Daily Press; 3 April 2003.

Wiseman, Paul. "Firms in Hong Kong try to ward off virus"; USA Today; 2 April 2003.

World Health Organization; http://www.who.int/csr/sars/en/