Risk factors for mechanical ventilation in U.S. children hospitalized with seasonal influenza and 2009 pandemic influenza A*.
Risk factors for mechanical ventilation in U.S. children hospitalized with seasonal influenza and 2009 pandemic influenza A*.
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DOI：
10.1097/pcc.0b013e318260114e
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发表时间：
2012-11
期刊：
影响因子：
--
通讯作者：
Randolph AG
中科院分区：
文献类型：
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作者：
Eriksson CO;Graham DA;Uyeki TM;Randolph AG
我们测试了这样一种假设，即在2009年H1N1甲型H1N1流感大流行(PH1N1)期间，因流感住院的儿童使用机械呼吸机支持的情况高于因季节性流感住院的儿童在调整患者风险后的预期。回顾性队列研究。43家美国儿科医院。2006年7月至2009年3月(季节性流感)和2009年6月至12月(PH1N1)确诊为流行性感冒的18岁儿童。没有。我们包括10,173名因季节性流感住院的儿童和9,837名推定为H1N1的儿童。PH1N1人群年龄较大(中位数5.0岁对1.9岁)，更有可能患有哮喘(30%对18%)，接受机械通气的可能性较小(7.1%[n=701]对9.2%[n=940])。使用Logistic回归，我们建立了季节性流感队列中与气管内机械呼吸机支持相关的危险因素的多变量模型，并使用该模型预测了假定为PH1N1的儿童预期机械通气病例的数量。调整了潜在的健康状况、种族、年龄和细菌性肺炎的共同诊断后，假定的PH1N1队列中的机械通气率为0.74(95%可信区间为0.68-0.79)。在季节性流感(OR0.66；95%CI，0.45-0.97)和PH1N1(OR0.23；95%CI，0.16-0.34)期间，早期使用抗病毒药物的患者在≥3住院日的机械通气量减少；在PH1N1期间使用抗病毒药物的比例要高得多(70%比19%，P<；0.001)。尽管在2009年甲型H1N1流感大流行期间，被诊断为出院的儿童人数几乎增加了两倍，但接受机械通风治疗的儿童的风险调整比例低于我们在季节性流感队列中预测的比例。医院早期使用流感抗病毒药物与迟发性机械通气量的减少有关。
We tested the hypothesis that use of mechanical ventilator support in children hospitalized with influenza during the 2009 H1N1 influenza A(H1N1) pandemic (pH1N1) was higher than would be expected in children hospitalized for seasonal influenza after adjusting for patient risk. Retrospective cohort study. 43 U.S. pediatric hospitals. Children <18 years old with a discharge diagnosis of influenza admitted July 2006 through March 2009 (seasonal influenza) and June through December 2009 (pH1N1). None. We included 10,173 children hospitalized with seasonal influenza and 9,837 with presumed pH1N1. The pH1N1 cohort was older (median 5.0 vs. 1.9 years), more likely to have asthma (30% vs. 18%), and less likely to receive mechanical ventilation (7.1% [n=701]) versus 9.2% [n=940]). Using logistic regression, we created a multivariable model of risk factors associated with endotracheal mechanical ventilator support in the seasonal influenza cohort and used this model to predict the number of expected mechanical ventilation cases in children with presumed pH1N1. Adjusted for underlying health conditions, race, age and a co-diagnosis of bacterial pneumonia, the observed/expected rate of mechanical ventilation in the presumed pH1N1 cohort was 0.74 (95% CI 0.68–0.79). Early hospital treatment with influenza antiviral medications was associated with decreased initiation of mechanical ventilation on hospital day ≥3 in the seasonal influenza (OR 0.66; 95% CI, 0.45–0.97) and pH1N1 (OR 0.23; 95% CI, 0.16–0.34) periods; influenza antiviral use in the pH1N1 period was much higher (70% versus 19%, P<0.001). Although the number of children with a hospital discharge diagnosis of influenza almost tripled during the 2009 pandemic H1N1 period, the risk-adjusted proportion of children receiving mechanical ventilation was lower than we would have predicted in a seasonal influenza cohort. Early hospital use of influenza antiviral medications was associated with a decrease in late-onset mechanical ventilation.