Critical illness in children with influenza A/pH1N1 2009 infection in Canada
Critical illness in children with influenza A/pH1N1 2009 infection in Canada
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DOI：
10.1097/pcc.0b013e3181d9c80b
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发表时间：
2010-09-01
影响因子：
4.1
通讯作者：
Fowler, Robert
中科院分区：
文献类型：
--
作者：
Jouvet, Philippe;Hutchison, Jamie;Fowler, Robert
目的：描述加拿大甲型流感/大流行性甲型流感病毒（pH1N1）感染的危重儿童的特征、治疗和结局。设计：对儿科重症监护病房（picu）感染甲型流感/pH1N1的危重患儿进行观察性研究。设置：9个加拿大picu。患者：2009年4月16日至2009年8月15日，共有57例患者入住picu。干预措施:没有。测量方法和主要结果：记录甲型流感/pH1N1感染危重患儿的特征。将重症监护室确诊病例与包含所有甲型流感/pH1N1感染住院儿科患者的国家监测数据库进行比较。采用Cox比例风险模型评估危险因素。采用卡方检验对PICU队列和国家监测数据进行比较。57名儿童因社区获得性甲型流感/pH1N1感染而入住PICU。70.2%的患者有一种或多种慢性合并症，24.6%的患者为原住民。68%患儿采用机械通气，20例患儿（35.1%）在入院第一天出现急性肺损伤，通气时间中位数为6天（范围0 ~ 67天）。PICU死亡率为7%（57例患者中有4例）。与非重症监护病房住院儿童相比，PICU儿童更容易出现慢性疾病（相对风险，1.73）；原住民种族不是重症监护病房入院的危险因素。结论：在甲型h1n1流感首次暴发期间，当人群对这种新型病毒不熟悉时，严重疾病在有潜在慢性病的儿童和土著儿童中很常见。甲型流感/ ph1n1相关的儿童危重疾病与严重低氧性呼吸衰竭和长时间机械通气相关。然而，与季节性流感相比，这种较高的呼吸道疾病发病率和严重程度并未导致死亡率增加。（儿科危重护理医学2010；11:603-609）
Objective: To describe characteristics, treatment, and outcomes of critically ill children with influenza A/pandemic influenza A virus (pH1N1) infection in Canada.Design: An observational study of critically ill children with influenza A/pH1N1 infection in pediatric intensive care units (PICUs).Setting: Nine Canadian PICUs.Patients: A total of 57 patients admitted to PICUs between April 16, 2009 and August 15, 2009.Interventions: None.Measurements and Main Results: Characteristics of critically ill children with influenza A/pH1N1 infection were recorded. Confirmed intensive care unit cases were compared with a national surveillance database containing all hospitalized pediatric patients with influenza A/pH1N1 infection. Risk factors were assessed with a Cox proportional hazard model. The PICU cohort and national surveillance data were compared, using chi-square tests. Fifty-seven children were admitted to the PICU for community-acquired influenza A/pH1N1 infection. One or more chronic comorbid illnesses were observed in 70.2% of patients, and 24.6% of patients were aboriginal. Mechanical ventilation was used in 68% of children, 20 children (35.1%) had acute lung injury on the first day of admission, and the median duration of ventilation was 6 days (range, 0-67 days). The PICU mortality rate was 7% (4 of 57 patients). When compared with nonintensive care unit hospitalized children, PICU children were more likely to have a chronic medical condition (relative risk, 1.73); aboriginal ethnicity was not a risk factor of intensive care unit admission.Conclusions: During the first outbreak of influenza A/pH1N1 infection, when the population was naive to this novel virus, severe illness was common among children with underlying chronic conditions and aboriginal children. Influenza A/pH1N1-related critical illness in children was associated with severe hypoxemic respiratory failure and prolonged mechanical ventilation. However, this higher rate and severity of respiratory illness did not result in an increased mortality when compared with seasonal influenza. (Pediatr Crit Care Med 2010; 11:603-609)