Published ahead of print on December 10, 2004, doi:10.1164/rccm.200405-621WS
© 2005 American Thoracic Society doi: 10.1164/rccm.200405-621WS
Clinical Issues and Research in Respiratory Failure from Severe Acute Respiratory SyndromeDepartment of Medicine, Brown University/Rhode Island Hospital, Providence, Rhode Island; Division of Antiviral Drug Products, Food and Drug Administration, Rockville, Maryland; Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Pulmonary and Mediastinal Pathology, Armed Forces Institute of Pathology, Washington, DC; Department of Internal Medicine, University of Virginia, Charlottesville, Virginia; Respiratory and Enteric Viruses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pulmonary and Critical Care Medicine, VA Puget Sound Medical Center, Seattle, Washington; Department of Medicine, Winthrop University Hospital, Mineola, New York; Department of Pulmonary and Critical Care Medicine, University of Washington at Harborview Medical Center, Seattle, Washington; Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Division of Lung Diseases, NHLBI/NIH, Bethesda, Maryland; Interdepartmental Division of Critical Care Medicine, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Critical Care Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada; Departments of Medicine and Critical Care, St. Michael's Hospital, Toronto, Ontario, Canada Correspondence and requests for reprints should be addressed to Andrea L. Harabin, Ph.D., Division of Lung Diseases, NHLBI/NIH, 6,701 Rockledge Drive, Room 10018, Bethesda, MD 20892-7952. E-mail: harabin{at}nih.gov ABSTRACT The National Heart, Lung, and Blood Institute, along with the Centers for Disease Control and Prevention and the National Institute of Allergy and Infectious Diseases, convened a panel to develop recommendations for treatment, prevention, and research for respiratory failure from severe acute respiratory syndrome (SARS) and other newly emerging infections. The clinical and pathological features of acute lung injury (ALI) from SARS appear indistinguishable from ALI from other causes. The mainstay of treatments for ALI remains supportive. Patients with ALI from SARS who require mechanical ventilation should receive a lung protective, low tidal volume strategy. Adjuvant treatments recommended include prevention of venous thromboembolism, stress ulcer prophylaxis, and semirecumbent positioning during ventilation. Based on previous experience in Canada, infection control resources and protocols were recommended. Leadership structure, communication, training, and morale are an essential aspect of SARS management. A multicenter, placebo-controlled trial of corticosteroids for late SARS is justified because of widespread clinical use and uncertainties about relative risks and benefits. Studies of combined pathophysiologic endpoints were recommended, with mortality as a secondary endpoint. The group recommended preparation for studies, including protocols, ethical considerations, Web-based registries, and data entry systems.
Key Words: acute lung injury • acute respiratory distress syndrome • infectious disease This article has been cited by other articles:
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