Critically Ill Patients With 2009 Influenza A(H1N1) Infection in Canada
Critically Ill Patients With 2009 Influenza A(H1N1) Infection in Canada
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DOI：
10.1001/jama.2009.1496
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发表时间：
2009-11-04
影响因子：
120.7
通讯作者：
Fowler, Robert A.
中科院分区：
文献类型：
--
作者：
Kumar, Anand;Zarychanski, Ryan;Fowler, Robert A.
背景2009年3月至7月，2009年甲型H1N1流感确诊病例最多的是北美地区。目的描述加拿大2009年甲型H1N1流感重症患者的特征、治疗和结局。设计、设置、4月16日至8月12日期间，在加拿大38个成人和儿科重症监护室（ICU）对168名2009年甲型H1N1流感感染的危重患者进行了一项前瞻性观察研究，2009.Main Outcome Measures主要结局指标为28天和90天死亡率。次要结局包括机械通气的频率和持续时间以及ICU stay.Results的持续时间，215例确诊（n=162）、可能（n=6）或疑似（n=47）2009年社区获得性甲型H1N1流感感染患者发生了危重疾病。在168例确诊或可能患有2009年甲型H1N1流感的患者中，平均（SD）年龄为32.3（21.4）岁; 113例为女性（67.3%），50例为儿童（29.8%）。重症患者28天的总死亡率为14.3%（95%置信区间，9.5%-20.7%）。有43例患者是加拿大土著人（25.6%）。从症状发作到住院的中位时间为4天（四分位距[IQR]，2-7天），从住院到入住ICU的中位时间为1天（IQR，0-2天）。休克和非肺部急性器官功能障碍很常见（第1天序贯器官衰竭评估平均[SD]评分为6.8 [3.6]）。152例患者（90.5%）接受了神经氨酸酶抑制剂治疗。所有患者在ICU入院时均严重低氧血症（PaO 2与吸入氧分数[FIO 2]的平均[SD]比值为147 [128] mm Hg）。机械通气136例（81.0%）。中位通气持续时间为12天（IQR，6-20天），ICU住院时间为12天（IQR，5-20天）。肺抢救治疗包括神经肌肉阻滞（28%的患者）、吸入一氧化氮（13.7%）、高频振荡通气（11.9%）、体外膜肺氧合（4.2%）和俯卧位通气（3.0%）。危重患者90天的总死亡率为17.3%（95%可信区间为12.0%~ 24.0%;结论加拿大2009年甲型H1N1流感导致的危重病在入院后迅速发生，通常发生在年轻人中，并与严重低氧血症，多系统器官衰竭，需要长时间机械通气，以及频繁使用急救疗法。美国医学会杂志2009;302（17）：1872-1879
Context Between March and July 2009, the largest number of confirmed cases of 2009 influenza A(H1N1) infection occurred in North America.Objective To describe characteristics, treatment, and outcomes of critically ill patients in Canada with 2009 influenza A(H1N1) infection.Design, Setting, and Patients A prospective observational study of 168 critically ill patients with 2009 influenza A(H1N1) infection in 38 adult and pediatric intensive care units (ICUs) in Canada between April 16 and August 12, 2009.Main Outcome Measures The primary outcome measures were 28-day and 90-day mortality. Secondary outcomes included frequency and duration of mechanical ventilation and duration of ICU stay.Results Critical illness occurred in 215 patients with confirmed (n=162), probable (n=6), or suspected (n=47) community-acquired 2009 influenza A(H1N1) infection. Among the 168 patients with confirmed or probable 2009 influenza A(H1N1), the mean(SD) age was 32.3 (21.4) years; 113 were female (67.3%) and 50 were children (29.8%). Overall mortality among critically ill patients at 28 days was 14.3% (95% confidence interval, 9.5%-20.7%). There were 43 patients who were aboriginal Canadians (25.6%). The median time from symptom onset to hospital admission was 4 days (interquartile range [IQR], 2-7 days) and from hospitalization to ICU admission was 1 day (IQR, 0-2 days). Shock and nonpulmonary acute organ dysfunction was common (Sequential Organ Failure Assessment mean [SD] score of 6.8 [3.6] on day 1). Neuraminidase inhibitors were administered to 152 patients (90.5%). All patients were severely hypoxemic (mean [SD] ratio of PaO2 to fraction of inspired oxygen [FIO2] of 147 [128] mm Hg) at ICU admission. Mechanical ventilation was received by 136 patients (81.0%). The median duration of ventilation was 12 days (IQR, 6-20 days) and ICU stay was 12 days (IQR, 5-20 days). Lung rescue therapies included neuromuscular blockade (28% of patients), inhaled nitric oxide (13.7%), high-frequency oscillatory ventilation (11.9%), extracorporeal membrane oxygenation (4.2%), and prone positioning ventilation (3.0%). Overall mortality among critically ill patients at 90 days was 17.3%(95% confidence interval, 12.0%-24.0%; n=29).Conclusion Critical illness due to 2009 influenza A(H1N1) in Canada occurred rapidly after hospital admission, often in young adults, and was associated with severe hypoxemia, multisystem organ failure, a requirement for prolonged mechanical ventilation, and the frequent use of rescue therapies. JAMA. 2009;302(17):1872-1879