Department of Anesthesiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Pediatr Crit Care Med. 2010 Mar;11(2):173-8. doi: 10.1097/PCC.0b013e3181ccedae.
To describe the presentation, course, and outcome of critically ill children with novel H1N1 influenza disease.
Retrospective case series.
Pediatric intensive care unit in an urban tertiary academic center.
Thirteen consecutive patients admitted between June 2009 and August 2009 and known or subsequently found to be infected with novel H1N1 influenza A.
None.
Clinical, laboratory, and radiographic data were reviewed. The patients were predominantly male (62%), aged 5 months to 21 yrs, and most (92%) had known risk factors for severe disease. Direct fluorescent antibody testing had a high false-negative rate (62%) and delayed treatment in some cases. The respiratory illness presented clinically with both bronchoconstriction and alveolar consolidation to varying degrees. Bacterial superinfection occurred frequently (23%). Forty-six percent of patients required mechanical ventilation and 23% required inotropic support for hypotension. None of the patients in this series required extracorporeal membrane oxygenation. Intensive care unit length of stay did not differ between an early (within 48 hrs) oseltamivir treatment group (length of stay, 4.2 +/- 4.4 days) vs. a late treatment group (length of stay, 6.8 +/- 8.8 days). All patients survived to hospital discharge.
Underlying chronic illness (especially respiratory illness) seems associated with critical novel H1N1 influenza disease in children. Respiratory manifestations are highly variable among patients and within a single patient involving both bronchoconstriction and alveolar disease. Therapies must be individualized and rapidly adjusted. The duration of critical illness was not different between early and late treatment groups. Whether this is reflective of sample size or indicative of the importance of therapeutic intervention at any time early during infection in critically ill patients is unclear. Bacterial superinfection was more common than previously reported for seasonal influenza A. Moderate novel H1N1 influenza disease, including respiratory failure and hypotension, had 100% survival in our series.
描述患有新型 H1N1 流感的危重症患儿的临床表现、病程和转归。
回顾性病例系列研究。
城市三级学术中心的儿科重症监护病房。
2009 年 6 月至 8 月间连续收治的 13 例已知或后来确诊为新型 H1N1 甲型流感感染的患者。
无。
回顾了临床、实验室和影像学资料。患者主要为男性（62%），年龄 5 个月至 21 岁，大多数（92%）有发生重症疾病的已知危险因素。直接荧光抗体检测的假阴性率较高（62%），在某些情况下导致治疗延迟。呼吸道疾病的临床表现既有支气管痉挛，也有不同程度的肺泡实变。细菌合并感染很常见（23%）。46%的患者需要机械通气，23%的患者因低血压需要正性肌力支持。本研究中没有患者需要体外膜氧合。入住重症监护病房的时间在早期（48 小时内）奥司他韦治疗组（住院时间为 4.2±4.4 天）和晚期治疗组（住院时间为 6.8±8.8 天）之间没有差异。所有患者均存活至出院。
基础慢性疾病（尤其是呼吸道疾病）似乎与儿童重症新型 H1N1 流感有关。患者之间以及同一患者的呼吸道表现差异很大，既有支气管痉挛又有肺泡疾病。治疗必须个体化并迅速调整。早期和晚期治疗组之间的危重症持续时间没有差异。这是反映样本量的结果，还是提示在感染的任何早期阶段对重症患者进行治疗干预的重要性，尚不清楚。细菌合并感染比以前报道的季节性甲型流感更为常见。在我们的系列研究中，中度新型 H1N1 流感，包括呼吸衰竭和低血压，均有 100%的存活率。
