Clinical characteristics and outcomes of patients with 2009 influenza A(H1N1) virus infection with respiratory failure requiring mechanical ventilation
Clinical characteristics and outcomes of patients with 2009 influenza A(H1N1) virus infection with respiratory failure requiring mechanical ventilation
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DOI：
10.1016/j.jcrc.2010.05.031
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发表时间：
2011-04-01
影响因子：
3.7
通讯作者：
Esteban, Andres
中科院分区：
文献类型：
--
作者：
Nin, Nicolas;Soto, Luis;Esteban, Andres
目的：本研究的目的是描述2009年甲型H1N1流感重症患者的临床特征和结局。方法：对确诊或可能感染2009年甲型H1N1流感并需要机械通气的呼吸衰竭患者进行观察性研究。结果：96例患者（平均年龄45岁，SD）， 44%为女性。43%和72%的患者在入院前72小时内被诊断为休克和急性呼吸窘迫综合征。45%的患者使用无创正压通气，但77%的患者失败。33%的病例被诊断为细菌性肺炎，8%在第一周内（由于社区获得性微生物），25%在第一周后（由于革兰氏阴性杆菌和耐药革兰氏阳性球菌）。重症监护病房死亡率为50%。非幸存者与幸存者在入院时心血管、呼吸和血液功能衰竭和晚期肺炎的患病率上存在差异。报告的死亡原因是难治性缺氧、多器官衰竭和休克（分别占所有死亡原因的50%、38%和12%）。结论：2009年甲型H1N1流感合并呼吸衰竭需要机械通气的患者常以急性呼吸窘迫综合征和休克为临床标准。细菌性肺炎是常见的并发症。死亡率很高，主要是由于难治性缺氧。(C) 2011爱思唯尔公司版权所有。
Purpose: The purpose of the study was to describe the clinical characteristics and outcomes of critically ill patients with 2009 influenza A(H1N1).Methods: An observational study of patients with confirmed or probable 2009 influenza A(H1N1) and respiratory failure requiring mechanical ventilation was performed.Results: We studied 96 patients (mean age, 45 [14] years [mean, SD]; 44% female). Shock and acute respiratory distress syndrome were diagnosed during the first 72 hours of admission in 43% and 72% of patients, respectively. Noninvasive positive pressure ventilation was used in 45% of the patients, but failed in 77% of them. Bacterial pneumonia was diagnosed in 33% of cases, 8% during the first week (due to community-acquired microorganisms) and 25% after the first week (due to gram-negative bacilli and resistant gram-positive cocci). Intensive care unit mortality was 50%. Nonsurvivors differed from survivors in the prevalence of cardiovascular, respiratory, and hematologic failure on admission and late pneumonia. Reported causes of death were refractory hypoxia, multiorgan failure, and shock (50%, 38%, and 12% of all causes of death, respectively).Conclusions: Patients with 2009 influenza A(H1N1) and respiratory failure requiring mechanical ventilation often present with clinical criteria of acute respiratory distress syndrome and shock. Bacterial pneumonia is a frequent complication. Mortality is high and is primarily due to refractory hypoxia. (C) 2011 Elsevier Inc. All rights reserved.