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

The ability of the APACHE II system in predicting group outcome is validated in this Canadian ICU population by receiver operating characteristic curve, 2 x 2 decision matrices and linear regression analysis. The Canadian patients had a higher overall hospital death rate than the United States patients. After controlling for severity of illness using APACHE II scores, the hospital death rate was comparable between the Canadian and United States patients.

We investigated the source of intravascular fat in systemic organs (brain, heart, and kidney) after massive pulmonary fat embolism during cemented arthroplasty. We used a bilateral cemented arthroplasty (BCA) in anesthetized mongrel dogs that simulates a cemented total-hip replacement procedure. We hypothesized that deformable fat globules could pass through the lung vasculature under high pulmonary artery pressure (Ppa). Using quantitative morphometry, we showed that the size of pulmonary vessel occluded by fat decreased from 12.8 +/- 15.2 microns 1 min after BCA to 4.9 +/- 5.1 microns at 120 min after BCA (p < 0.01). Ultrastructural studies demonstrated no evidence of acute inflammation around fat-occluded pulmonary vessels 3 h after BCA. Intravascular fat was found in all brain, heart, and kidney specimens examined 3 h after BCA (n = 6). No anesthetized animal in the "sham" (no BCA) group (n = 3) had intravascular fat at the same time period. Radiolabeled microspheres (15 microns diameter) did not reach the systemic circulation (< 1% nonentrapment) under the high Ppa after BCA. No patent foramen ovale was found in any dog at postmortem examination. We conclude that fat globules can traverse the pulmonary circulation within 3 h of orthopedic surgery. The difference between solid microspheres and fat in transpulmonary passage suggests that the composition, perhaps the deformability, of embolic material influences the lung's filtering capacity.