University of California, San Francisco, 94143-0131, USA.
Am J Med. 2010 Mar;123(3):282-285.e2. doi: 10.1016/j.amjmed.2009.11.004.
Acute respiratory distress syndrome resulting from novel influenza A virus (H1N1) infection remains uncommon.
We describe the clinical profiles of adult patients with acute respiratory distress syndrome due to microbiologically confirmed H1N1 admitted to a medical intensive care unit in San Francisco, California over a 2-month period.
Between June 1 and July 31, 2009, 7 patients (age range: 25-66 years; 4 patients under the age of 40 years; 6 male; 1 pregnant) were diagnosed with H1N1, with 5 of 6 (83%) having initial false-negative rapid testing. All developed respiratory failure complicated by acute respiratory distress syndrome, with 4 additionally developing multiorgan dysfunction. All were managed with a lung protective ventilator strategy (average number of days on the ventilator: 16), and 4 patients also required additional rescue therapies for refractory hypoxemia, including very high positive end-expiratory pressure, inhaled epoprostenol, recruitment maneuvers, and prone positioning. Despite these measures, 3 patients (43%) ultimately died.
Clinicians should be vigilant for the potential of H1N1 infection to progress to severe acute respiratory distress syndrome in a variety of patient demographics, including younger patients without baseline cardiopulmonary disease. A high degree of suspicion is critical, especially with the relative insensitivity of rapid testing, and should prompt empiric antiviral therapy.
新型甲型 H1N1 流感病毒引起的急性呼吸窘迫综合征仍然少见。
我们描述了在加利福尼亚州旧金山的一家医疗重症监护病房中，在两个月的时间内，因微生物学确诊的 H1N1 而患有急性呼吸窘迫综合征的成年患者的临床特征。
在 2009 年 6 月 1 日至 7 月 31 日期间，7 名患者（年龄范围：25-66 岁；40 岁以下患者 4 名；6 名男性；1 名孕妇）被诊断患有 H1N1，其中 6 名中的 5 名（83%）最初快速检测结果呈假阴性。所有患者均发生呼吸衰竭合并急性呼吸窘迫综合征，其中 4 名患者还发生多器官功能障碍。所有患者均采用肺保护性通气策略进行治疗（呼吸机使用天数平均为 16 天），4 名患者还需要其他治疗方法来治疗难治性低氧血症，包括高呼气末正压、吸入前列环素、复张手法和俯卧位通气。尽管采取了这些措施，仍有 3 名患者（43%）最终死亡。
临床医生应警惕各种患者人群中 H1N1 感染进展为严重急性呼吸窘迫综合征的可能性，包括无基础心肺疾病的年轻患者。高度怀疑是至关重要的，特别是由于快速检测的相对不敏感性，应促使进行经验性抗病毒治疗。
