Hospital Joan XXIII, Critical Care Department, IISPV, URV, CIBER Enfermedades Respiratorias, Tarragona, Spain.
Med Intensiva. 2011 May;35(4):208-16. doi: 10.1016/j.medin.2011.03.001. Epub 2011 Apr 14.
During the 2009 influenza pandemic, several reports were published, nevertheless, data on the clinical profiles of critically ill patients with the new virus infection during this second outbreak are still lacking.
Prospective, observational, multi-center study conducted in 148 Spanish intensive care units (ICU) during epidemiological weeks 50-52 of 2010 and weeks 1 - 4 of 2011.
Three hundred patients admitted to an intensive care unit (ICU) with confirmed An/H1N1 infection were analyzed. The median age was 49 years [IQR=38-58] and 62% were male. The mean APACHE II score was 16.9 ± 7.5 and the mean SOFA score was 6.3 ± 3.5 on admission. Comorbidities were present in 76% (n=228) of cases and 111 (37.4%) patients were reportedly obese and 59 (20%) were COPD. The main presentation was viral pneumonia with severe hypoxemia in 65.7% (n=197) of the patients whereas co-infection was identified in 54 (18%) patients. All patients received antiviral treatment and initiated empirically in 194 patients (65.3%), however only 53 patients (17.6%) received early antiviral treatment. Vaccination was only administered in 22 (7.3%) patients. Sixty-seven of 200 patients with ICU discharge died. Haematological disease, severity of illness, infiltrates in chest X-ray and need for mechanical ventilation were variables independently associated with ICU mortality.
In patients admitted to the ICU in the post-pandemic seasonal influenza outbreak vaccination was poorly implemented and appear to have higher frequency of severe comorbidities, severity of illness, incidence of primary viral pneumonia and increased mortality when compared with those observed in the 2009 pandemic outbreak.
在 2009 年流感大流行期间，发表了几篇报告，但仍缺乏关于新病毒感染危重症患者临床特征的第二波爆发的数据。
这是一项前瞻性、观察性、多中心研究，于 2010 年流行病学第 50-52 周和 2011 年第 1-4 周在 148 家西班牙重症监护病房（ICU）进行。
分析了 300 名因确诊的 An/H1N1 感染而入住 ICU 的患者。中位年龄为 49 岁[IQR=38-58]，62%为男性。入院时平均 APACHE II 评分为 16.9±7.5，平均 SOFA 评分为 6.3±3.5。76%（n=228）的病例存在合并症，111 例（37.4%）患者肥胖，59 例（20%）患有 COPD。主要表现为病毒性肺炎，伴有严重低氧血症的患者占 65.7%（n=197），而 54 例（18%）患者存在合并感染。所有患者均接受抗病毒治疗，194 例（65.3%）患者经验性开始治疗，但仅有 53 例（17.6%）患者接受早期抗病毒治疗。仅对 22 例（7.3%）患者进行了疫苗接种。200 例 ICU 出院患者中有 67 例死亡。血液系统疾病、疾病严重程度、胸部 X 线浸润和机械通气需求是与 ICU 死亡率相关的独立变量。
在季节性流感大流行后的 ICU 住院患者中，疫苗接种实施情况较差，与 2009 年大流行相比，这些患者更常患有严重的合并症、疾病严重程度更高、原发性病毒性肺炎发生率更高，死亡率也更高。
