ブックタイトル第43回日本集中治療医学会学術集会プログラム・抄録集

概要

第43回日本集中治療医学会学術集会プログラム・抄録集

－181－SL5Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, SouthKoreaGee Young SuhThe Middle East respiratory syndrome（MERS）is an emerging lethal respiratory disease caused by a novel betacoronavirus（MERS-CoV）, and most cases of MERS have been reported from the countries in or near the Arabian Peninsula. In May of2015, a Korean gentlemen who visited the Middle East fell ill with respiratory symptoms and pneumonia. He visited threemedical facilities before finally being confirmed of having MERS at Samsung Medical Center. But before the diagnosis he spreadthe disease to 28 patients. One of these secondary cases of MERS who was not told that he was exposed to MERS-CoV, visitedemergency room of Samsung Medical Center due to unresolving pneumonia and stayed for 3 days in the crowded emergencyroom while spreading the disease to over 80 people. An unprecedented nosocomial outbreak of MERS occurred.Most of critically-ill MERS patients came to the ICU due to respiratory failure. The incidence of renal failure was not as high asprevious reports from Saudi Arabia. It is especially important to observe patients with pneumonia carefully for signs ofdeterioration because the respiratory failure can progress very rapidly especially early in the course of disease. Most patientsreceived anti-viral therapy according to the guidelines developed by the Korean Society of Infectious Diseases. In some patientsECMO was necessary due to progressing respiratory failure.Some of the problems facing when caring for these critically-ill patients were, 1）overcoming fear, 2）having enough medicalpersonnel to properly care for these patients, 3）logistics of transferring the patients, 4）education of personal protectionequipment for those taking care of these patients, 5）having proper facilities.Unexpected MERS-CoV outbreak occurred in Korea between May and July 2015 which totaled 186 patients with about 20%mortality. Doctors and nurses did what they did with what knowledge and resources that they had to overcome this tragedy.特別講演 5 2月12日（金）　14：40～15：05　第8会場MERS in SeoulSL6Intensive Care Department Medical Director, Respiratory Services Professor, College of Medicine King Saud Bin AbdulazizUniversity for Health Sciences King Abdulaziz Medical City Riyadh, Kingdom of Saudi ArabiaYaseen ArabiBetween September 2012 and 26 December 2015, 1,621 laboratory-confirmed human cases of Middle East respiratory syndromecoronavirus（MERS-CoV）infection from 26 countries, including at least 584 deaths（case fatality proportion 35%）, have beenreported to the World Health Organization. 80 %（1281）of these cases have been reported from Saudi Arabia including twomajor outbreaks one in early 2014 and mid 2015 this year. The patients presented with clinical symptoms and signs of a SARI,the most common being fever, dyspnea and cough. Some patients present with abdominal pain, vomiting and diarrhea. Up to70% of reported cases in some series developed ARDS requiring ICU admission and invasive mechanical ventilation. Nearly halfof the patients（48%）required renal replacement therapy. Other laboratory findings reported in MERS-CoV confirmed casesincluded lymphopenia, leukopenia and less commonly thrombocytopenia, anemia, elevated liver transaminases. Increasing age（>60 years）, male gender（66%）, underlying co morbidity: particularly diabetes（50%）, chronic cardiac disease（41%）, chronicrespiratory disease（40%）, chronic or end stage renal disease（30%）, those on hemodialysis or immunocompromised have beenfound to be the risk factors for poor prognosis in MERS-CoV patients. Treatment remains supportive and multiple gaps remainin the pathogenesis and specific therapy. Compliance with infection control is essential in preventing nosocomial transmission.特別講演 6 2月12日（金）　15：05～15：30　第8会場Infection with the Middle East Respiratory coronavirus（MERS-CoV）