tetano
Editor, Senior Moderator
Lung Function and Organ Dysfunctions in 178 Patients Requiring Mechanical Ventilation,During The 2009 Influenza A(H1N1) Pandemic
Fernando G Rios, Elissa Estenssoro, Fernando Villarejo, Ricardo Valentini, Liliana Aguilar, Daniel E Pezzola, Pascual Valdez, Miguel Blasco, Cristina Orlandi, Javier Alvarez, Fernando Saldarini, Alejandro Gomez, Pablo E Gomez, Martin Deheza, Alan Zazu, Monica Quinteros, Javier Osatnik, Ariel Chena, Damian Violi, Maria EUGENIA Gonzalez and Guillermo Chiappero
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Critical Care 2011, 15:R201 doi:10.1186/cc10369
Published: 17 August 2011
Abstract (provisional)
Background Most cases of 2009 influenza A(H1N1) infection are self-limited, but occasionally the disease evolves to a severe condition needing hospitalization. Here we describe the evolution of the respiratory compromise, ventilatory management and laboratory variables of patients with diffuse viral pneumonitis caused by pandemic 2009 influenza A(H1N1) admitted to the ICU. Method This was a multicenter, prospective inception cohort study including adult patients with acute respiratory failure requiring mechanically ventilation (MV), admitted to 20 ICUs in Argentina between June and September of 2009 during the influenza A(H1N1) pandemic. In a standard case-report form, we collected epidemiological characteristics, results of RT-PCR viral diagnostic tests, oxygenation variables, acid-base status, respiratory mechanics, ventilation management and laboratory tests. Variables were recorded on ICU admission and at days 3, 7 and 10. Results During the study period 178 patients with diffuse viral pneumonitis requiring MV were admitted. They had 4415 years, APACHE II of 187, and most frequent comorbidities were obesity (26%), previous respiratory disease (24%) and immunosuppression (16%). Non-invasive ventilation (NIV) was applied in 49(28%) patients on admission, but 94% were later intubated. ARDS was present throughout the entire ICU stay in the whole group (mean PaO2FIO2 17025). Tidal-volumes used were 7.8-8.1 ml/kg (ideal body weight), plateau pressures always remained <30 cmH2O, without differences between survivors and nonsurvivors; and mean PEEP levels used were between 8-12 cmH2O. Rescue therapies, like recruitment maneuvers (8-35%), prone positioning (12-24%) and tracheal gas insufflation (3%) were frequently applied. At all time points, pH, platelet count, LDH and SOFA differed significantly between survivors and nonsurvivors. Lack of recovery of platelet count and persistence of leukocytosis were characteristic of nonsurvivors. Mortality was high (46%); and length of MV was of 10[6-17] days. Conclusions These patients had severe, hypoxemic respiratory failure compatible with ARDS that persisted over time, frequently requiring adjuvants of MV to support oxygenation. NIV use is not warranted, given its high failure rate. Death and evolution to prolonged mechanical ventilation were common outcomes. Persistence of thrombocytopenia, acidosis and leukocytosis, and high LDH levels, found in nonsurvivors during the course of the disease might be novel prognostic findings.
http://ccforum.com/content/pdf/cc10369.pdf
Fernando G Rios, Elissa Estenssoro, Fernando Villarejo, Ricardo Valentini, Liliana Aguilar, Daniel E Pezzola, Pascual Valdez, Miguel Blasco, Cristina Orlandi, Javier Alvarez, Fernando Saldarini, Alejandro Gomez, Pablo E Gomez, Martin Deheza, Alan Zazu, Monica Quinteros, Javier Osatnik, Ariel Chena, Damian Violi, Maria EUGENIA Gonzalez and Guillermo Chiappero
For all author emails, please log on.
Critical Care 2011, 15:R201 doi:10.1186/cc10369
Published: 17 August 2011
Abstract (provisional)
Background Most cases of 2009 influenza A(H1N1) infection are self-limited, but occasionally the disease evolves to a severe condition needing hospitalization. Here we describe the evolution of the respiratory compromise, ventilatory management and laboratory variables of patients with diffuse viral pneumonitis caused by pandemic 2009 influenza A(H1N1) admitted to the ICU. Method This was a multicenter, prospective inception cohort study including adult patients with acute respiratory failure requiring mechanically ventilation (MV), admitted to 20 ICUs in Argentina between June and September of 2009 during the influenza A(H1N1) pandemic. In a standard case-report form, we collected epidemiological characteristics, results of RT-PCR viral diagnostic tests, oxygenation variables, acid-base status, respiratory mechanics, ventilation management and laboratory tests. Variables were recorded on ICU admission and at days 3, 7 and 10. Results During the study period 178 patients with diffuse viral pneumonitis requiring MV were admitted. They had 4415 years, APACHE II of 187, and most frequent comorbidities were obesity (26%), previous respiratory disease (24%) and immunosuppression (16%). Non-invasive ventilation (NIV) was applied in 49(28%) patients on admission, but 94% were later intubated. ARDS was present throughout the entire ICU stay in the whole group (mean PaO2FIO2 17025). Tidal-volumes used were 7.8-8.1 ml/kg (ideal body weight), plateau pressures always remained <30 cmH2O, without differences between survivors and nonsurvivors; and mean PEEP levels used were between 8-12 cmH2O. Rescue therapies, like recruitment maneuvers (8-35%), prone positioning (12-24%) and tracheal gas insufflation (3%) were frequently applied. At all time points, pH, platelet count, LDH and SOFA differed significantly between survivors and nonsurvivors. Lack of recovery of platelet count and persistence of leukocytosis were characteristic of nonsurvivors. Mortality was high (46%); and length of MV was of 10[6-17] days. Conclusions These patients had severe, hypoxemic respiratory failure compatible with ARDS that persisted over time, frequently requiring adjuvants of MV to support oxygenation. NIV use is not warranted, given its high failure rate. Death and evolution to prolonged mechanical ventilation were common outcomes. Persistence of thrombocytopenia, acidosis and leukocytosis, and high LDH levels, found in nonsurvivors during the course of the disease might be novel prognostic findings.
http://ccforum.com/content/pdf/cc10369.pdf