Sandrock Christian E
Division of Pulmonary and Critical Care, University of California Davis School of Medicine, 4150 V Street, #3400, Sacramento CA 95817, USA.
Respir Care. 2008 Jan;53(1):40-53; discussion 53-7.
Febrile respiratory illnesses with respiratory failure are one of the most common reasons for admission to the intensive care unit. Most causes of febrile respiratory illness are bacterial and viral agents of community-acquired pneumonia. However, a small number of rare and highly contagious agents can initially present as febrile respiratory illnesses, which can lead to an epidemic that can greatly impact the health care system. This impact includes sustained mass critical care, with potential scarcity of critical resources (eg, positive-pressure ventilators), spread of disease to health care workers, sustained spread within the community, and extensive morbidity and mortality. The main agents of febrile respiratory illness that would lead to an epidemic include influenza, the coronavirus that causes severe acute respiratory syndrome, smallpox, viral hemorrhagic fever, plague, tularemia, and anthrax. Recognition of these agents occurs largely based on epidemiological clues, and management consists of antibiotics, antivirals, supportive care, and positive-pressure ventilation. Acute respiratory failure and acute respiratory distress syndrome occur with these agents, so a lung-protective (low tidal volume) ventilation strategy is indicated. Additional respiratory care measures, such as nebulized medications, bronchoscopy, humidified oxygen, and airway suctioning, potentiate aerosolization of the virus or bacteria and increase the risk of transmission to health care workers and patients. Thus, appropriate personal protective equipment, including an N95 mask or powered air-purifying respirator, is indicated. A basic understanding of the epidemiology, clinical findings, diagnosis, and treatment of these agents will provide a foundation for early isolation, evaluation, infection control, and public health involvement and response in cases of a febrile respiratory illness that causes respiratory failure.
伴有呼吸衰竭的发热性呼吸道疾病是入住重症监护病房最常见的原因之一。发热性呼吸道疾病的大多数病因是社区获得性肺炎的细菌和病毒病原体。然而，少数罕见且具有高度传染性的病原体最初可能表现为发热性呼吸道疾病，这可能导致疫情爆发，对医疗保健系统产生重大影响。这种影响包括持续的大规模重症监护，可能出现关键资源（如正压通气机）短缺、疾病传播给医护人员、在社区内持续传播以及广泛的发病和死亡。可能导致疫情爆发的发热性呼吸道疾病的主要病原体包括流感、导致严重急性呼吸综合征的冠状病毒、天花、病毒性出血热、鼠疫、兔热病和炭疽。对这些病原体的识别主要基于流行病学线索，治疗包括使用抗生素、抗病毒药物、支持性治疗和正压通气。这些病原体可导致急性呼吸衰竭和急性呼吸窘迫综合征，因此应采用肺保护性（低潮气量）通气策略。其他呼吸护理措施，如雾化药物、支气管镜检查、湿化氧气和气道吸引，会增加病毒或细菌的气溶胶化，并增加传播给医护人员和患者的风险。因此，应使用适当的个人防护设备，包括N95口罩或动力空气净化呼吸器。对这些病原体的流行病学、临床表现、诊断和治疗有基本的了解，将为发热性呼吸道疾病导致呼吸衰竭时的早期隔离、评估、感染控制以及公共卫生参与和应对提供基础。
