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The Use of Drotrecogin Alfa (activated) in a Patient With Severe Acute Respiratory Syndrome FREE TO VIEW

Warda Farooq, BSc, MD; Donna McRitchie, MD, MSc, FRCSC
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North York General Hospital, Toronto, ON, Canada


Chest. 2003;124(4_MeetingAbstracts):272S. doi:10.1378/chest.124.4_MeetingAbstracts.272S
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INTRODUCTION:  A 34-year-old female with severe acute respiratory syndrome (SARS) developed multi-system organ failure. We discuss her therapy with drotrecogin alfa (activated) (DrotAA) and her clinical course. SARS has been recently recognised in Asia, North America and Europe. The World Health Organisation (WHO), has defined a suspected case of SARS as: documented fever (temperature >38 C), lower respiratory tract symptoms, contact with a person believed to have had SARS or a history of travel to a geographic area where there has been documented transmission of the illness. Global efforts to understand the cause, and to prevent the spread of, SARS were instituted in March 2003. The likely cause of SARS is believed to be a novel coronavirus. SARS typically presents as a febrile illness, which may lead to hypoxia, lung infiltrates and respiratory failure. In the ICU setting, patients requiring intubation and ventilation have significant associated morbidity and mortality. These patients may have additional associated organ dysfunction, and may represent a form of severe sepsis.

CASE PRESENTATION:  A 34-year-old female health-care worker was diagnosed with SARS. The patient presented with a one-week history of fever, dyspnea, fatigue, non-productive cough and pulmonary infiltrates on chest radiography. There was progressive deterioration over 24-hours and the patient required intubation and developed signs of multi-system organ dysfunction. The patient met the inclusion criteria for treatment with DrotAA, as published in The Canadian Journal of Infectious Diseases, “Guidance on patient identification and administration of recombinant human activated protein C for the treatment of severe sepsis.”DISCUSSION: This patient was treated with DrotAA at 24_g/kg/hour for 96-hours. The multisystem organ dysfunction involving the renal, hepatic and coagulation system reversed during her course of therapy with DrotAA. Creatinine returned to baseline 24-hours after completion of DrotAA therapy, and metabolic acidosis reversed by day 4 of DrotAA therapy. AST and ALT improved within 48 hours of initiation of DrotAA and had returned to baseline by day 4. The patient was weaned from inotropes and vasopressors by the end of DrotAA therapy, but she continued to require ventilatory support as single system respiratory dysfunction persisted. At the time of this report, after 5 weeks of maximum ventilatory support, she is continuing to slowly improve.

CONCLUSION:  Treatment with drotrecogin alfa (activated) appeared to have benefit in this SARS case. This is the first known reported use of drotrecogin alfa (activated) in a SARS case.

DISCLOSURE:  W. Farooq, None.

Monday, October 27, 2003

4:15 PM - 5:45 PM




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