Transmission of Severe Acute Respiratory Syndrome during Intubation and Mechanical Ventilation

Fowler, Robert; Guest, Cameron B.; Lapinsky, Stephen E.; Sibbald, William J.; Louie, Marie; Tang, Patrick; Simor, Andrew E.; Stewart, Thomas E.

doi:10.1164/rccm.200305-715oc

Cited by 270 publications

(290 citation statements)

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“…Since 26% of SARS patients required intubation, clearly the number of HCWs would rapidly decline if a similar trend occurred during a future outbreak. 2 This unique dataset provides compelling evidence that aggressive measures are required to protect HCWs from viral transmission.…”

Section: Discussionmentioning

confidence: 99%

“…A Risk Analysis Framework is presented to facilitate the rapid integration of HCWs' experiences into practice guidelines. [1][2][3][4] These protocols were based on the consensus opinion of infectious disease experts but were initially guided by minimal clinical data. Procedural lists and protocols were frequently revised during the epidemic, sometimes changing several times over the course of a day.…”

Section: Purposementioning

confidence: 99%

“…2 Anesthesiologists and other critical care providers were considered to be at particular risk for infection during endotracheal intubation because the primary mode of transmission was thought to be through contact of mucous membranes with infectious respiratory droplets or fomites. 2 Airway management protocols were quickly developed by infection control experts who often lacked expertise in the management of airway problems, and experts in airway management who lacked expertise in infection control. Furthermore, some protocols were proposed by caregivers that had no experience treating SARS patients.…”

Section: Purposementioning

confidence: 99%

See 2 more Smart Citations

Intubation of SARS patients: infection and perspectives of healthcare workers

Caputo

Byrick

Chapman

et al. 2006

Can J Anesth/J Can Anesth

103

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Purpose:The outbreak of severe acute respiratory syndrome (SARS) in 2003 presented major challenges to the safety of anesthesiologists and other healthcare workers (HCWs). This study determined the incidence of SARS transmission to HCWs who intubated patients and analyzed the concerns of HCWs regarding personal and patient safety. Methods: Healthcare workers who performed tracheal intubation in 10 Toronto hospitals were identified using the Ontario Public Health database. A questionnaire was used to collect information from the HCWs. To determine if the patterns of personal protection or concerns changed over time, data were analyzed according to whether the intubation occurred during SARS 1 (February 23 to April 21) or SARS 2 (April 22 to July 1). Results: Thirty-three HCWs who performed 39 intubations on 35 SARS patients were interviewed. Three of 23 HCWs (13%) acquired SARS during SARS 1 whereas none (0/10) acquired SARS during SARS 2. Personal protection increased from SARS 1 to SARS 2 and HCWs' concerns changed over time. During SARS 1, concerns focused on the need for personal protective equipment whereas during SARS 2, concerns focused on the need for strict training and patient care protocols. HCWs perceived that their experiences were ineffectively integrated into risk management protocols. Conclusions: Protection guidelines failed to completely prevent the transmission of SARS to HCWs. Nine percent of the interviewed HCWs who intubated patients contracted SARS. A Risk Analysis Framework is presented to facilitate the rapid integration of HCWs' experiences into practice guidelines. Objectif : L'éclosion du syndrome respiratoire aigu sévère (SRAS) en 2003 a présenté des défis importants à la sécurité des anesthésiologistes et des autres travailleurs de la santé (TS). L'étude a déterminé l'incidence de transmission du SRAS aux TS qui ont intubé des patients et a analysé les préoccupations des TS concernant la sécurité du personnel et des patients. Méthode : Nous avons repéré les TS qui ont réalisé des intubations dans 10 hôpitaux de Toronto grâce à la base de données sur la santé publique de l'Ontario. Un questionnaire a été utilisé pour recueillir les informations des TS. Pour vérifier si les modèles de protection individuelle et les préoccupations avaient changé avec le temps, l'analyse a tenu compte des intubations réalisées pendant les phases I ou II du SRAS

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Section: Discussionmentioning

confidence: 99%

Section: Purposementioning

confidence: 99%

Section: Purposementioning

confidence: 99%

See 1 more Smart Citation

Intubation of SARS patients: infection and perspectives of healthcare workers

Caputo

Byrick

Chapman

et al. 2006

Can J Anesth/J Can Anesth

103

View full text Add to dashboard Cite

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“…in SARS patients [8,9,[11][12][13][14][15][16][17]. It is well known that ETI is associated with higher risk of disease transmission and associated complications.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive mechanical ventilation in high-risk pulmonary infections: a clinical review

et al. 2014

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The aim of this article was to review the role of noninvasive ventilation (NIV) in acute pulmonary infectious diseases, such as severe acute respiratory syndrome (SARS), H1N1 and tuberculosis, and to assess the risk of disease transmission with the use of NIV from patients to healthcare workers.We performed a clinical review by searching Medline and EMBASE. These databases were searched for articles on ''clinical trials'' and ''randomised controlled trials''. The keywords selected were non-invasive ventilation pulmonary infections, influenza-A (H1N1), SARS and tuberculosis. These terms were crossreferenced with the following keywords: health care workers, airborne infections, complications, intensive care unit and pandemic. The members of the International NIV Network examined the major results regarding NIV applications and SARS, H1N1 and tuberculosis. Cross-referencing mechanical ventilation with SARS yielded 76 studies, of which 10 studies involved the use of NIV and five were ultimately selected for inclusion in this review. Cross-referencing with H1N1 yielded 275 studies, of which 27 involved NIV. Of these, 22 were selected for review. Cross-referencing with tuberculosis yielded 285 studies, of which 15 involved NIV and from these seven were selected. In total 34 studies were selected for this review.NIV, when applied early in selected patients with SARS, H1N1 and acute pulmonary tuberculosis infections, can reverse respiratory failure. There are only a few reports of infectious disease transmission among healthcare workers. @ERSpublications NIV in high risk pulmonary infection management can prevent respiratory failure in ICUs with well trained staff

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“…This might have happened especially with patient five, who was already receiving mechanical ventilation when he entered the hospital ward. Intubation and other droplet-generating procedures have been shown to increase the risk of transmitting infectious agents to HCWs [5], who might thereafter induce and sustain the circulation of virus between patients. It is known that the trivalent inactivated vaccine (TIV) against seasonal influenza has a 70-90% efficacy in healthy adults under 65 years of age [10].…”

Section: Discussionmentioning

confidence: 99%