Department of Critical Care, Vall d'Hebron University Hospital, Barcelona, Spain.
Curr Opin Crit Care. 2012 Oct;18(5):441-50. doi: 10.1097/MCC.0b013e32835605f2.
Shortly after the advent of severe acute respiratory syndrome and the avian influenza, the emergence of the influenza A(H1N1)2009 pandemic caused significant vibrations to the public health authorities and stressed the health systems worldwide. We sought to investigate whether this experience has altered our knowledge and our current and future practice on the management of severe acute respiratory infections (SARI) and community-acquired pneumonia.
A changing epidemiology was demonstrated, with obesity and pregnancy beyond established risk groups for influenza A, other clinical syndromes beyond primary viral pneumonia, possible coinfections by other viral beyond bacterial pathogens and a disappointing performance of all available severity assessment tools. On the treatment topic, accumulating evidence suggesting worse outcomes argues against the use of corticosteroids, but some noninvasive ventilating modalities require further assessment.
The recent influenza A(H1N1)2009 pandemic has highlighted our weaknesses relating to the diagnosis and assessment of severity of SARI, compromising early treatment and ultimate outcomes; further research based on this experience will help to improve prognosis and boost our future preparedness. An important message is the necessity of international collaboration for the rapid dissemination of locally acquired knowledge.
严重急性呼吸综合征和禽流感出现后不久，甲型 H1N1 流感大流行的爆发对公共卫生当局造成了重大冲击，并对全球卫生系统造成了压力。我们试图探讨这一经历是否改变了我们对严重急性呼吸道感染（SARI）和社区获得性肺炎管理的知识以及当前和未来的实践。
表现出不断变化的流行病学特征，肥胖症和妊娠超出了甲型流感的既定风险群体，除了原发性病毒性肺炎以外的其他临床综合征，除了细菌病原体以外，其他病毒的可能合并感染，以及所有现有严重程度评估工具的令人失望的性能。在治疗方面，越来越多的证据表明，皮质类固醇的使用会导致更差的结果，但一些非侵入性通气方式需要进一步评估。
最近的甲型 H1N1 流感大流行凸显了我们在 SARI 的诊断和严重程度评估方面的弱点，这影响了早期治疗和最终结果；基于这一经验的进一步研究将有助于改善预后并增强我们未来的准备。一个重要信息是，必须进行国际合作，以便快速传播当地获得的知识。
