Virus-induced acute respiratory distress syndrome: epidemiology, management and outcome.
Virus-induced acute respiratory distress syndrome: epidemiology, management and outcome.
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DOI：
10.1016/j.lpm.2011.05.027
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发表时间：
2011-12
期刊：
影响因子：
--
通讯作者：
Chastre J
中科院分区：
文献类型：
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作者：
Luyt CÉ;Combes A;Trouillet JL;Nieszkowska A;Chastre J
急性呼吸窘迫综合征（ARDS）可由病毒性疾病引起，有两种病毒类型负责：引起社区获得性病毒性肺炎的呼吸道病毒和引起医院获得性病毒性肺炎的疱疹病毒科。在可影响肺部并导致ARDS的呼吸道病毒中，流行性病毒位居榜首，最近发现的流感病毒为H5N1和H1N1 2009。然而，其他病毒可导致严重的ARDS。值得注意的是，一种新型冠状病毒是2003年严重急性呼吸系统综合征爆发的原因。除了这些大流行性病毒外，呼吸道病毒很少引起病毒性肺炎和ARDS。除了抗病毒药物（主要是奥司他韦）给药和避免皮质类固醇外，这些病毒引起的ARDS的管理与其他疾病引起的ARDS没有区别。在疱疹病毒科中，单纯疱疹病毒（HSV）和巨细胞病毒（CMV）是引起可演变成ARDS的医院内病毒性肺炎的两种病毒。HSV经常在机械通气患者的呼吸道中恢复，有时可能导致HSV支气管肺炎。虽然没有评估这一适应症，阿昔洛韦可以是一种治疗选择HSV支气管肺炎和ARDS患者。CMV肺炎也可发生在机械通气患者中，但很难诊断，因为病毒恢复并不一定意味着病毒性疾病。更昔洛韦可用于ARDS和经组织学或细胞学证实的CMV肺炎患者。
The acute respiratory distress syndrome (ARDS) can be induced by viral diseases, with two virus types being responsible: respiratory viruses that cause community-acquired viral pneumonia and Herpesviridae that cause nosocomial viral pneumonia. Among the respiratory viruses that can affect the lung and cause ARDS, pandemic viruses head the list, with influenza viruses H5N1 and H1N1 2009 being the most recently identified. However, other viruses can cause severe ARDS. Notably, a novel coronavirus was responsible for the severe acute respiratory syndrome outbreak in 2003. Apart from these pandemic viruses, respiratory viruses are rarely responsible for viral pneumonia and ARDS. Other than antiviral drug (mainly oseltamivir) administration and avoidance of corticosteroids, management of ARDS due to these viruses does not differ from that for ARDS caused by other diseases. Among Herpesviridae, herpes simplex virus (HSV) and cytomegalovirus (CMV) are the two viruses causing nosocomial viral pneumonia that can evolve into ARDS. HSV is frequently recovered in the respiratory tract of mechanically ventilated patients and can sometimes be responsible for HSV bronchopneumonitis. Although not evaluated for this indication, acyclovir can be a therapeutic option for patients with HSV bronchopneumonitis and ARDS. CMV pneumonia can also occur in mechanically ventilated patients, but is difficult to diagnose because virus recovery does not necessarily mean viral disease. Ganciclovir can be considered for patients with ARDS and histology- or cytology-proven CMV pneumonia.