Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France.
Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France.
Chest. 2012 Sep;142(3):583-592. doi: 10.1378/chest.11-2196.
No data on long-term outcomes of survivors of 2009 influenza A(H1N1) (A[H1N1])-associated ARDS are available. The objective of this study was to compare the 1-year outcomes of survivors of A(H1N1)-associated ARDS, according to use or no use of extracorporeal lung assist (ECLA), using its need as an ARDS severity surrogate.
Survivors of ARDS (12 with ECLA use vs 25 without, corresponding to 75% and 54% of the eligible patients for each group, respectively) selected from the Réseau Européen de Ventilation Artificielle (REVA) registry had previously been healthy, with only pregnancy and/or moderate obesity (BMI ≤ 35 kg/m²) as known risk factors for A(H1N1) infection. Lung function and morphology, health-related quality of life (HRQoL), and psychologic impairment were evaluated.
At 1 year post-ICU discharge for the ECLA and no-ECLA groups, respectively, 50% and 40% reported significant exertion dyspnea, 83% and 64% had returned to work, and 75% and 64% had decreased diffusion capacity across the blood-gas barrier, despite their near-normal and similar lung function test results. For both groups, exercise test results showed diminished but comparable exercise capacities, with similar alveolar-arterial oxygen gradients at peak exercise, and CT scans showed minor abnormal findings. HRQoL assessed by the 36-Item Short-Form Health Survey was poorer for both groups than for a sex- and age-matched general population group, but without between-group differences. ECLA and no-ECLA group patients, respectively, had symptoms of anxiety (50% and 56%) and depression (28% and 28%) and were at risk for posttraumatic stress disorder (41% and 44%).
One year post-ICU discharge, a majority of survivors of A(H1N1)-associated ARDS had minor lung disabilities with diminished diffusion capacities across the blood-gas barrier, and most had psychologic impairment and poorer HRQoL than a sex- and age-matched general population group. ECLA and no-ECLA group patients had comparable outcomes.
ClinicalTrials.gov; No.: NCT01271842; URL: www.clinicaltrials.gov
目前尚无关于 2009 年甲型 H1N1（A[H1N1]）相关急性呼吸窘迫综合征（ARDS）幸存者长期结局的数据。本研究的目的是比较使用和未使用体外肺辅助（ECLA）的 A（H1N1）相关 ARDS 幸存者的 1 年结局，使用 ECLA 需求作为 ARDS 严重程度的替代指标。
从欧洲人工通气网络（REVA）登记处中选择 ARDS 幸存者（12 例使用 ECLA 与 25 例未使用 ECLA，分别对应于每组符合条件患者的 75%和 54%），这些患者之前均健康，仅有妊娠和/或中度肥胖（BMI≤35kg/m²）作为 A（H1N1）感染的已知危险因素。评估肺功能和形态、健康相关生活质量（HRQoL）和心理障碍。
在 ECLA 和无 ECLA 组 ICU 出院后 1 年，分别有 50%和 40%报告有明显的用力呼吸困难，83%和 64%已恢复工作，75%和 64%的人血-气屏障扩散能力下降，尽管他们的肺功能测试结果接近正常且相似。对于两组，运动试验结果均显示运动能力下降，但相似，最大运动时肺泡-动脉氧梯度相似，CT 扫描显示轻微异常发现。36 项简明健康调查问卷评估的 HRQoL 均低于性别和年龄匹配的一般人群组，但两组间无差异。ECLA 和无 ECLA 组患者分别有 50%和 56%有焦虑症状和 28%和 28%有抑郁症状，有创伤后应激障碍风险的分别为 41%和 44%。
在 ICU 出院后 1 年，大多数 A（H1N1）相关 ARDS 幸存者的肺功能残疾程度较小，血-气屏障扩散能力下降，大多数幸存者有心理障碍和较差的 HRQoL，比性别和年龄匹配的一般人群组差。ECLA 和无 ECLA 组患者的结局相似。
ClinicalTrials.gov；编号：NCT01271842；网址：www.clinicaltrials.gov
