Introduction

Severe acute respiratory syndrome (SARS) is clinically severe with a high proportion of cases, approximately 20%, requiring intensive care unit (ICU) admission. The provision of organ support in the ICU therefore plays a potentially important role in reducing mortality, which may be as high as 10% for younger patients and 50% for patients older than 60 years. Radiological imaging of the chest is important because of the overriding importance of respiratory failure in determining the management and outcome of SARS.

At the time of writing there were little published data detailing the ICU management and outcome of SARS, and much the information that follow are based on the observational data derived from our institution.

ICU admission

Patients generally present to the hospital with fever, chills, rigors, myalgia, headache and a non-productive cough. Common laboratory features include an elevated serum lactate dehydrogenase (LDH) concentration, lymphopaenia, hypocalcaemia and moderate thrombocytopaenia. SARS is a slowly progressive disease and the average interval from the onset of symptoms to requirement for ICU admission is approximately 10 days. Clinical deterioration of cases admitted to the ward is manifested by progressive hypoxia and dyspnoea, and is accompanied by progression of pulmonary infiltrates on chest radiograph. Close monitoring of disease progress in the general wards is therefore important to detect deterioration in those patients who will be admitted to ICU.