Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome
Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome
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DOI：
10.1001/jama.2009.1535
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发表时间：
2009-11-04
影响因子：
120.7
通讯作者：
Ziegenfuss, Marc
中科院分区：
文献类型：
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作者：
Davies, Andrew;Jones, Daryl;Ziegenfuss, Marc
2009年南半球冬季，新型甲型H1N1流感大流行影响了澳大利亚和新西兰。引起危重症流行，部分患者出现严重急性呼吸窘迫综合征（ARDS），采用体外膜氧合（ECMO）治疗。目的描述所有经ECMO治疗的2009年甲型流感（H1N1）相关ARDS患者的特征，并报告发病率、资源利用和患者结局。设计、环境和患者一项观察性研究，对2009年6月1日至8月31日期间澳大利亚和新西兰15个重症监护病房（icu）中所有接受ECMO治疗的2009年甲型流感（H1N1）相关ARDS患者（n=68）进行研究。主要观察指标发生率、临床特征、肺功能障碍程度、技术特征、ECMO持续时间、并发症和生存率。结果68例严重流感相关ARDS患者接受ECMO治疗，其中61例确诊为2009年甲型H1N1流感（n=53）或甲型流感未亚型（n=8），发生率为每百万人口2.6例ECMO病例。另外133例甲型流感患者在同一icu中接受了机械通气，但没有进行ECMO。68例接受ECMO的患者中位（四分位间距[IQR]）年龄为34.4（26.6-43.1）岁，34例（50%）为男性。在ECMO前，尽管有先进的机械通气支持，患者仍有严重的呼吸衰竭，中位（IQR） PaO(2)/吸入氧分数（FIO(2)）比为56(48-63)，呼气末正压为18 (15-20)cm H(2)O，急性肺损伤评分为3.8（3.5-4.0）。ECMO支持的中位（IQR）持续时间为10（7-15）天。在报告时，68例患者中有48例（71%；95%可信区间[CI]， 60%-82%）存活至ICU出院，其中32例存活至出院，16例仍住院。14例患者（21%;95% CI, 11%-30%）死亡，6例仍在ICU，其中2例仍在接受ECMO。2009年6月至8月期间，澳大利亚和新西兰地区转诊中心的icu为许多2009年甲型H1N1流感相关呼吸衰竭患者提供了机械通气，其中三分之一的患者接受了ECMO。这些接受ecmo治疗的患者通常是患有严重低氧血症的年轻人，在研究结束时死亡率为21%。《美国医学协会杂志》上。2009年;302 (17): 1888 - 1895
Context The novel influenza A(H1N1) pandemic affected Australia and New Zealand during the 2009 southern hemisphere winter. It caused an epidemic of critical illness and some patients developed severe acute respiratory distress syndrome (ARDS) and were treated with extracorporeal membrane oxygenation (ECMO).Objectives To describe the characteristics of all patients with 2009 influenza A(H1N1) associated ARDS treated with ECMO and to report incidence, resource utilization, and patient outcomes.Design, Setting, and Patients An observational study of all patients (n=68) with 2009 influenza A(H1N1)-associated ARDS treated with ECMO in 15 intensive care units (ICUs) in Australia and New Zealand between June 1 and August 31, 2009.Main Outcome Measures Incidence, clinical features, degree of pulmonary dysfunction, technical characteristics, duration of ECMO, complications, and survival.Results Sixty-eight patients with severe influenza-associated ARDS were treated with ECMO, of whom 61 had either confirmed 2009 influenza A(H1N1) (n=53) or influenza A not subtyped (n=8), representing an incidence rate of 2.6 ECMO cases per million population. An additional 133 patients with influenza A received mechanical ventilation but no ECMO in the same ICUs. The 68 patients who received ECMO had a median (interquartile range [IQR]) age of 34.4 (26.6-43.1) years and 34 patients (50%) were men. Before ECMO, patients had severe respiratory failure despite advanced mechanical ventilatory support with a median (IQR) PaO(2)/fraction of inspired oxygen (FIO(2)) ratio of 56 (48-63), positive end-expiratory pressure of 18 (15-20) cm H(2)O, and an acute lung injury score of 3.8 (3.5-4.0). The median (IQR) duration of ECMO support was 10 (7-15) days. At the time of reporting, 48 of the 68 patients (71%; 95% confidence interval [CI], 60%-82%) had survived to ICU discharge, of whom 32 had survived to hospital discharge and 16 remained as hospital inpatients. Fourteen patients (21%; 95% CI, 11%-30%) had died and 6 remained in the ICU, 2 of whom were still receiving ECMO.Conclusions During June to August 2009 in Australia and New Zealand, the ICUs at regional referral centers provided mechanical ventilation for many patients with 2009 influenza A(H1N1) -associated respiratory failure, one-third of whom received ECMO. These ECMO-treated patients were often young adults with severe hypoxemia and had a 21% mortality rate at the end of the study period. JAMA. 2009;302(17):1888-1895