Division of Pediatric Critical Care, Ankara University School of Medicine, Ankara, Turkey.
Pediatr Crit Care Med. 2012 Jan;13(1):e11-7. doi: 10.1097/PCC.0b013e31820aba37.
To outline the epidemiologic features, clinical presentation, clinical courses, and outcomes in critically ill children with pandemic influenza in pediatric intensive care units.
Retrospective, observational, multicenter study.
Thirteen tertiary pediatric intensive care units in Turkey.
Eighty-three children with confirmed infection attributable to pandemic influenza detected by reverse-transcriptase polymerase chain reaction assay between November 1 and December 31, 2009 who were admitted to critical care units.
None.
During a 2-month period, 532 children were hospitalized with pandemic influenza and 83 (15.6%) needed critical care. For the 83 patients requiring critical care, the median age was 42 (range, 2-204) months, with 24 (28.9%) and 48 (57.8%) of patients younger than 2 and 5 yrs, respectively. Twenty (24.1%) patients had no underlying illness, but 63 (75.9%) children had an underlying chronic illness. Indications for admission to the pediatric intensive care unit were respiratory failure in 66 (79.5%), neurologic deterioration in six (7.2%), and gastrointestinal symptoms in five (6.0%) patients. Acute lung injury was diagnosed in 23 (27.7%), acute respiratory distress syndrome was diagnosed in 34 (41%), and 51 (61.4%) patients were mechanically ventilated. Oseltamivir was used in 80 (96%) patients. The mortality rate for children with pandemic influenza 2009 was 30.1% compared to an overall mortality rate of 13.7% (p = .0016) among pediatric intensive care unit patients without pandemic influenza during the study period. Also, the mortality rate was 31.7% in patients with comorbidities and 25.0% in previously healthy children (p = .567). The cause of death was primary pandemic influenza infection in 16 (64%), nosocomial infection in four (16%), and primary disease progression in five (20%) patients. The odds ratio for respiratory failure was 14.7 (95% confidence interval, 1.85-111.11), and odds ratio for mechanical ventilation was 27.7 (95% confidence interval, 0.003-200).
Severe disease and high mortality rates were seen in children with pandemic influenza. Death attributable to pandemic influenza occurred in all age groups of children with or without underlying illness. Multiple organ dysfunction syndrome is associated with increased mortality, and death is frequently secondary to severe lung infection caused by pandemic influenza.
概述在儿科重症监护病房中患有大流行性流感的危重症儿童的流行病学特征、临床表现、临床病程和转归。
回顾性、观察性、多中心研究。
土耳其的 13 家三级儿科重症监护病房。
2009 年 11 月 1 日至 12 月 31 日期间通过逆转录酶聚合酶链反应检测证实感染大流行性流感且入住重症监护病房的 83 名儿童。
无。
在 2 个月期间，532 名儿童因大流行性流感住院，83 名（15.6%）需要重症监护。对于需要重症监护的 83 名患者，中位年龄为 42 岁（范围，2-204 个月），年龄小于 2 岁和 5 岁的患者分别为 24 名（28.9%）和 48 名（57.8%）。20 名（24.1%）患者无基础疾病，但 63 名（75.9%）患儿有基础慢性疾病。入儿科重症监护病房的指征为呼吸衰竭 66 例（79.5%）、神经恶化 6 例（7.2%）和胃肠道症状 5 例（6.0%）。诊断为急性肺损伤 23 例（27.7%）、急性呼吸窘迫综合征 34 例（41.0%）和 51 例（61.4%）患者需机械通气。80 名（96.0%）患儿使用了奥司他韦。与研究期间儿科重症监护病房无大流行性流感的患儿总体死亡率 13.7%相比，2009 年大流行性流感患儿的死亡率为 30.1%（p=0.0016）。此外，合并症患儿的死亡率为 31.7%，既往健康儿童的死亡率为 25.0%（p=0.567）。16 名（64%）患儿的死亡原因为大流行性流感原发性感染，4 名（16%）患儿的死亡原因为医院获得性感染，5 名（20%）患儿的死亡原因为原发性疾病进展。呼吸衰竭的优势比为 14.7（95%置信区间，1.85-111.11），机械通气的优势比为 27.7（95%置信区间，0.003-200）。
患有大流行性流感的儿童疾病严重且死亡率高。大流行性流感导致的死亡发生在有或无基础疾病的所有年龄组的儿童中。多器官功能障碍综合征与死亡率增加相关，死亡常继发于大流行性流感引起的严重肺部感染。
