Richard Jean-Christophe Marie, Pham Tài, Brun-Buisson Christian, Reignier Jean, Mercat Alain, Beduneau Gaëtan, Régnier Bernard, Mourvillier Bruno, Guitton Christophe, Castanier Matthias, Combes Alain, Le Tulzo Yves, Brochard Laurent
Crit Care. 2012 Jul 9;16(4):R118. doi: 10.1186/cc11412.
The specific burden imposed on Intensive Care Units (ICUs) during the A/H1N1 influenza 2009 pandemic has been poorly explored. An on-line screening registry allowed a daily report of ICU beds occupancy rate by flu infected patients (Flu-OR) admitted in French ICUs.
We conducted a prospective inception cohort study with results of an on-line screening registry designed for daily assessment of ICU burden.
Among the 108 centers participating to the French H1N1 research network on mechanical ventilation (REVA) - French Society of Intensive Care (SRLF) registry, 69 ICUs belonging to seven large geographical areas voluntarily participated in a website screening-registry. The aim was to daily assess the ICU beds occupancy rate by influenza-infected and non-infected patients for at least three weeks. Three hundred ninety-one critically ill infected patients were enrolled in the cohort, representing a subset of 35% of the whole French 2009 pandemic cohort; 73% were mechanically ventilated, 13% required extra corporal membrane oxygenation (ECMO) and 22% died. The global Flu-OR in these ICUs was only 7.6%, but it exceeded a predefined 15% critical threshold in 32 ICUs for a total of 103 weeks. Flu-ORs were significantly higher in University than in non-University hospitals. The peak ICU burden was poorly predicted by observations obtained at the level of large geographical areas.
The peak Flu-OR during the pandemic significantly exceeded a 15% critical threshold in almost half of the ICUs, with an uneven distribution with time, geographical areas and between University and non-University hospitals. An on-line assessment of Flu-OR via a simple dedicated registry may contribute to better match resources and needs.
2009年甲型H1N1流感大流行期间重症监护病房（ICU）所承受的具体负担尚未得到充分研究。一个在线筛查登记系统能够每日报告法国各ICU中流感感染患者的ICU床位占用率（Flu-OR）。
我们开展了一项前瞻性队列研究，采用一个旨在每日评估ICU负担的在线筛查登记系统的结果。
在参与法国H1N1机械通气研究网络（REVA）——法国重症监护学会（SRLF）登记系统的108个中心中，属于七个大地理区域的69个ICU自愿参与了一个网站筛查登记系统。目的是每日评估流感感染和未感染患者的ICU床位占用率，为期至少三周。391例重症感染患者被纳入该队列，占2009年法国整个大流行队列的35%；73%接受机械通气，13%需要体外膜肺氧合（ECMO），22%死亡。这些ICU的总体Flu-OR仅为7.6%，但在32个ICU中超过了预先设定的15%的临界阈值，总计103周。大学医院的Flu-OR显著高于非大学医院。在大地理区域层面获得的观察结果对ICU负担峰值的预测效果不佳。
大流行期间的Flu-OR峰值在近一半的ICU中显著超过了15%的临界阈值，在时间、地理区域以及大学医院和非大学医院之间分布不均。通过一个简单的专用登记系统对Flu-OR进行在线评估可能有助于更好地匹配资源和需求。
