Critically ill infants and children with influenza A (H1N1) in pediatric intensive care units in Argentina
Critically ill infants and children with influenza A (H1N1) in pediatric intensive care units in Argentina
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DOI：
10.1007/s00134-010-1853-1
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发表时间：
2010-06-01
影响因子：
38.9
通讯作者：
Esteban, Andres
中科院分区：
文献类型：
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作者：
Farias, Julio A.;Fernandez, Analia;Esteban, Andres
为了确定流行病学特征，当然，甲型流感（H1N1）病毒重症儿科患者的预后。因甲型流感（H1N1）病毒感染而入住儿科重症监护室（PICU）的儿童的前瞻性队列。阿根廷三级保健医院的17个内外科PICU。所有连续入住PICU的甲型流感（H1N1）患者2009年6月15日至7月31日期间的病毒感染。在PICU的437例急性下呼吸道感染患者中，147例（34%）被诊断为与危重病相关的甲型H1N1流感。这些患者的中位年龄为10个月（IQR 3-59）。入院时117例（84%）使用有创机械通气。急性呼吸窘迫综合征（ARDS）发生率为80%（118/147）。22次尝试中有19次（86%）初始无创通气失败。第28天时的死亡率为39%（n = 57）。慢性复杂疾病（CCC）、急性肾功能不全（ARD）和MV第3天的PaO 2/FiO（2）比值与较高的死亡风险独立相关。CCC的比值比（OR）为3.06（CI 95% 1.36-6.84）; ARD的OR为3.38（CI 95% 1.45-10.33）; PaO 2/FiO（2）的OR为4（CI 95% 1.57-9.59）。入院后24 h内给予奥司他韦具有保护作用：OR 0.2（95%CI 0.07-0.54）。在患有ARDS的儿童中，H1N1作为病原体赋予高死亡率，并且在此类患者中存在CCC增加了死亡风险。
To determine the epidemiological features, course, and outcomes of critically ill pediatric patients with Influenza A (H1N1) virus.Prospective cohort of children in pediatric intensive care units (PICUs) due to Influenza A (H1N1) virus infection.Seventeen medical-surgical PICUs in tertiary care hospital in Argentina.All consecutive patients admitted to the PICUs with influenza A (H1N1) viral infection from 15 June to 31 July 2009.Of 437 patients with acute lower respiratory infection in PICUs, 147 (34%) were diagnosed with influenza A (H1N1) related to critical illness. The median age of these patients was 10 months (IQR 3-59). Invasive mechanical ventilation was used in 117 (84%) on admission. The rate of acute respiratory distress syndrome (ARDS) was 80% (118 of 147 patients). Initial non-invasive ventilation failed in 19 of 22 attempts (86%). Mortality at 28 days was 39% (n = 57). Chronic complex conditions (CCCs), acute renal dysfunction (ARD) and ratio PaO2/FiO(2) at day 3 on MV were independently associated with a higher risk of mortality. The odds ratio (OR) for CCCs was 3.06, (CI 95% 1.36-6.84); OR for ARD, 3.38, (CI 95% 1.45-10.33); OR for PaO2/FiO(2), 4 (CI 95% 1.57-9.59). The administration of oseltamivir within 24 h after admission had a protective effect: OR 0.2 (CI 95% 0.07-0.54).In children with ARDS, H1N1 as an etiologic agent confers high mortality, and the presence of CCCs in such patients increases the risk of death.