Department of Medicine, Utah Valley Regional Medical Center, Provo, UT 84604, USA.
J Intensive Care Med. 2012 May-Jun;27(3):184-90. doi: 10.1177/0885066610396168. Epub 2011 May 18.
A number of different modalities have been employed in addition to conventional ventilation to improve oxygenation in patients with severe 2009 pandemic influenza A (H1N1) pneumonia. Outcomes with ventilatory and rescue therapies for H1N1 influenza-related acute respiratory distress syndrome (ARDS) have been varied. A single intensive care unit (ICU) experience with management of laboratory-confirmed 2009 pandemic influenza A (H1N1) ARDS with a combination of proning and airway pressure release ventilation (APRV) is described.
A retrospective review of medical records of ICU patients seen at Utah Valley Regional Medical Center during the first and second waves of the H1N1 influenza pandemic was done.
Fourteen ICU patients were managed with invasive ventilation for 2009 pandemic influenza A (H1N1)-related ARDS. Hypoxemia refractory to conventional ventilation was noted in 11 of 14 patients despite application of APRV. Following proning in patients on APRV, improvement of hypoxemia and hemodynamic status was achieved. Only 2 of 11 patients on APRV and proning required continuous dialysis. Mortality in intubated patients receiving a combination of proning and APRV was 27.3% (3/11) with 2 of these dying during the first wave of the H1N1 influenza pandemic. In all, 3 of 11 patients on proning and APRV underwent tracheostomy, with 2 of these undergoing tube thoracostomy. ARDSnet fluid-conservative protocol was safely tolerated in 8 of 11 of the intubated patients following initiation of proning and APRV.
Proning in combination with APRV provides improvement of hypoxemia with limitation of end-organ dysfunction and thereby facilitates recovery from severe 2009 pandemic influenza A (H1N1).
除了常规通气之外，已经采用了许多不同的方式来改善严重 2009 年大流行甲型流感（H1N1）肺炎患者的氧合。甲型 H1N1 流感相关急性呼吸窘迫综合征（ARDS）的通气和抢救治疗的结果各不相同。描述了一个单一的重症监护病房（ICU）对实验室确诊的 2009 年大流行甲型流感（H1N1）ARDS 进行管理的经验，该经验采用俯卧位和气道压力释放通气（APRV）的组合。
对犹他谷地区医疗中心在 H1N1 流感大流行的第一波和第二波期间 ICU 患者的病历进行了回顾性审查。
14 名 ICU 患者因 2009 年大流行甲型流感（H1N1）相关 ARDS 接受了有创通气。尽管应用了 APRV，但仍有 14 名患者中的 11 名患者出现常规通气难治性低氧血症。在 APRV 俯卧位的患者中，低氧血症和血液动力学状态得到改善。仅在 APRV 和俯卧位的 11 名患者中的 2 名需要连续透析。接受俯卧位和 APRV 联合治疗的插管患者的死亡率为 27.3％（3/11），其中 2 人死于 H1N1 流感大流行的第一波。总共，在俯卧位和 APRV 的 3 名患者进行了气管切开术，其中 2 名进行了胸腔管切开术。在开始俯卧位和 APRV 后，8 名插管患者中有 8 名安全耐受 ARDSnet 液体保守方案。
俯卧位联合 APRV 可改善低氧血症，限制终末器官功能障碍，从而促进严重 2009 年大流行甲型流感（H1N1）的康复。
