Pandemic 2009 Influenza A in Argentina A Study of 337 Patients on Mechanical Ventilation
Pandemic 2009 Influenza A in Argentina A Study of 337 Patients on Mechanical Ventilation
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DOI：
10.1164/201001-0037oc
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发表时间：
2010-07-01
影响因子：
24.7
通讯作者：
Valdez, Pascual
中科院分区：
文献类型：
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作者：
Estenssoro, Elisa;Rios, Fernando G.;Valdez, Pascual
理由。 2009 年甲型流感 (H1N1) 在世界范围内的迅速传播凸显了对流行病学、临床特征、结果和死亡预测因素有更好的了解的必要性，特别是在最严重的情况下。 目的：描述 6 月 3 日至 6 月 3 日至 6 月 3 日至 6 月 3 日期间，阿根廷 35 个重症监护室收治的 2009 年甲型流感 (H1N1) 流感引起的确诊、疑似和疑似病毒性肺炎患者的这些特征，这些患者患有需要机械通气的急性呼吸衰竭。 9 月 7 日。方法：起始队列研究，包括 337 名连续成年患者。数据以阿根廷重症监护协会网站上发布的表格形式收集。测量和主要结果：确诊病例、可能病例或疑似病例的比例分别为 39%、8% 和 53%，并且具有相似的结果。 APACHE II 为 18 +/- 7；年龄 47 +/- 17 岁； 56%为男性； 64% 的人患有基础疾病，其中肥胖（24%）、慢性阻塞性呼吸道疾病（18%）和免疫抑制（15%）是最常见的。百分之七怀孕了。入院时，患者出现严重低氧血症（Pa-O2/Fi(O2) 140 [87-200]）、广泛的肺部放射学浸润（2.87 +/- 1.03 象限）和细菌合并感染（25%；大多数为肺炎链球菌）。经常使用诸如肺复张操作（40%）和俯卧位（13%）、休克（72%）和需要血液透析的急性肾损伤（17%）等辅助手段。死亡率为 46%，各个年龄段的死亡率相似。 APACHE II、最低 Pa-O2/Fi(O2)、休克、血液透析、俯卧位和肺炎链球菌合并感染独立预测死亡。结论：需要机械通气的 2009 年甲型 H1N1 流感患者大多是中年人，通常有合并症，经常出现严重急性呼吸窘迫综合征和需要高级器官支持的多器官衰竭。病死率相应较高。
Rationale. The rapid spread of the 2009 Influenza A (H1N1) around the world underscores the need for a better knowledge of epidemiology, clinical features, outcomes, and mortality predictors, especially in the most severe presentations.Objectives: To describe these characteristics in patients with confirmed, probable, and suspected viral pneumonia caused by 2009 influenza A (H1N1) admitted to 35 intensive care units with acute respiratory failure requiring mechanical ventilation in Argentina, between June 3 and September 7.Methods: Inception-cohort study including 337 consecutive adult patients. Data were collected in a form posted on the Argentinian Society of Intensive Care website.Measurements and Main Results: Proportions of confirmed, probable, or suspected cases were 39%, 8%, and 53% and had similar outcomes. APACHE II was 18 +/- 7; age 47 +/- 17 years; 56% were male; and 64% had underlying conditions, with obesity (24%), chronic obstructive respiratory disease (18%), and immunosupression (15%) being the most common. Seven percent were pregnant. On admission, patients had severe hypoxemia (Pa-O2/Fi(O2) 140 [87-200]), extensive lung radiologic infiltrates (2.87 +/- 1.03 quadrants) and bacterial coinfection, (25%; mostly with Streptococcus pneumoniae). Use of adjuvants such as recruitment maneuvers (40%) and prone positioning (13%), and shock (72%) and acute kidney injury requiring hemodialysis (17%), were frequent. Mortality was 46%, and was similar across all ages. APACHE II, lowest Pa-O2/Fi(O2),, shock, hemodialysis, prone positioning, and S. pneumoniae coinfection independently predicted death.Conclusions: Patients with 2009 influenza A (H1N1) requiring mechanical ventilation were mostly middle-aged adults, often with comorbidities, and frequently developed severe acute respiratory distress syndrome and multiorgan failure requiring advanced organ support. Case fatality rate was accordingly high.