Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710, USA.
Respir Care. 2011 Jul;56(7):941-6. doi: 10.4187/respcare.01066. Epub 2011 Feb 21.
Respiratory failure and acute respiratory distress syndrome secondary to H1N1 influenza infection is a source of substantial morbidity and mortality, having caused over 265,000 hospitalizations in the United States in 2009. During the H1N1 pandemic, up to 31% of the H1N1 patients required intensive care unit admission, and many were refractory to maximal conventional therapies. These most critically ill patients may require extracorporeal membrane oxygenation (ECMO) for survival.
We retrospectively reviewed the medical records of the 7 patients with refractory hypoxemia due to H1N1 influenza who were treated with ECMO in our pediatric intensive care unit.
Five of the 7 patients survived to hospital discharge. The cohort's mean age was 21 years, and 4 were female. At admission to the pediatric intensive care unit, 6 had at least one comorbid condition, 6 were mechanically ventilated, and one was in shock. All 7 patients were treated with oral oseltamivir, high-frequency oscillatory ventilation, and inhaled nitric oxide prior to ECMO. Five received intravenous steroids, and 2 were treated with compassionate-use intravenous zanamivir. The mean duration of pre-ECMO ventilation was 8.7 days (range 14 h to 25 d). Mean oxygenation index was 50 (range 26-73) at ECMO cannulation. Six received venovenous ECMO, and one received venoarterial ECMO. The mean duration of ECMO was 432 hours (range 192-890 h).
This series suggests that ECMO is a viable treatment for refractory hypoxemia secondary to H1N1 influenza infection in both pediatric and adult patients.
由 H1N1 流感感染引起的呼吸衰竭和急性呼吸窘迫综合征是导致大量发病率和死亡率的原因，2009 年在美国导致超过 265000 例住院治疗。在 H1N1 大流行期间，多达 31%的 H1N1 患者需要入住重症监护病房，许多患者对最大常规治疗方法没有反应。这些病情最严重的患者可能需要体外膜氧合（ECMO）才能存活。
我们回顾性地审查了在我们的儿科重症监护病房中因 H1N1 流感导致难治性低氧血症而接受 ECMO 治疗的 7 例患者的病历。
7 例患者中有 5 例存活至出院。该队列的平均年龄为 21 岁，有 4 例为女性。入儿科重症监护病房时，6 例患者至少有一种合并症，6 例患者需要机械通气，1 例患者休克。所有 7 例患者在接受 ECMO 治疗之前均接受了口服奥司他韦、高频振荡通气和吸入一氧化氮治疗。5 例患者接受了静脉注射类固醇治疗，2 例患者接受了同情用静脉注射扎那米韦治疗。ECMO 前机械通气的平均时间为 8.7 天（范围为 14 小时至 25 天）。ECMO 插管时的平均氧合指数为 50（范围为 26-73）。6 例患者接受了静脉-静脉 ECMO，1 例患者接受了静脉-动脉 ECMO。ECMO 的平均持续时间为 432 小时（范围为 192-890 小时）。
本系列研究表明，ECMO 是治疗儿童和成人因 H1N1 流感感染引起的难治性低氧血症的可行治疗方法。
