Department of Pediatrics, Children's National Medical Center Washington, DC, USA.
Pediatr Crit Care Med. 2013 May;14(4):356-65. doi: 10.1097/PCC.0b013e31828a70fe.
Pertussis persists in the United States despite high immunization rates. This report characterizes the presentation and acute course of critical pertussis by quantifying demographic data, laboratory findings, clinical complications, and critical care therapies among children requiring admission to the PICU.
Prospective cohort study.
Eight PICUs comprising the Eunice Kennedy Shriver National Institute for Child Health and Human Development Collaborative Pediatric Critical Care Research Network and 17 additional PICUs across the United States.
Eligible patients had laboratory confirmation of pertussis infection, were younger than 18 years old, and died in the PICU or were admitted to the PICU for at least 24 hours between June 2008 and August 2011.
None.
A total of 127 patients were identified. Median age was 49 days, and 105 (83%) patients were less than 3 months old. Fifty-five (43%) patients required mechanical ventilation and 12 patients (9.4%) died during initial hospitalization. Pulmonary hypertension was found in 16 patients (12.5%) and was present in 75% of patients who died, compared with 6% of survivors (p < 0.001). Median WBC was significantly higher in those requiring mechanical ventilation (p < 0.001), those with pulmonary hypertension (p < 0.001), and nonsurvivors (p < 0.001). Age, sex, and immunization status did not differ between survivors and nonsurvivors. Fourteen patients received leukoreduction therapy (exchange transfusion [12], leukopheresis [1], or both [1]). Survival benefit was not apparent.
Pulmonary hypertension may be associated with mortality in pertussis critical illness. Elevated WBC is associated with the need for mechanical ventilation, pulmonary hypertension, and mortality risk. Research is indicated to elucidate how pulmonary hypertension, immune responsiveness, and elevated WBC contribute to morbidity and mortality and whether leukoreduction might be efficacious.
尽管美国的免疫接种率很高，但百日咳仍在持续存在。本报告通过量化人口统计学数据、实验室结果、临床并发症以及需要入住儿科重症监护病房（PICU）的儿童的重症监护治疗方法，描述了严重百日咳的表现和急性病程。
前瞻性队列研究。
由 Eunice Kennedy Shriver 国家儿童健康与人类发展研究所合作儿科重症监护研究网络中的 8 个 PICU 和美国其他 17 个 PICU 组成。
符合实验室确诊百日咳感染条件、年龄小于 18 岁、2008 年 6 月至 2011 年 8 月期间在 PICU 死亡或至少入住 PICU 24 小时的患者。
无。
共确定了 127 名患者。中位年龄为 49 天，105 名（83%）患者年龄小于 3 个月。55 名（43%）患者需要机械通气，12 名患者（9.4%）在初始住院期间死亡。16 名（12.5%）患者存在肺动脉高压，且死亡患者中有 75%存在肺动脉高压，而幸存者中只有 6%存在肺动脉高压（p < 0.001）。需要机械通气的患者（p < 0.001）、存在肺动脉高压的患者（p < 0.001）和非幸存者（p < 0.001）的白细胞计数中位数显著更高。幸存者和非幸存者在年龄、性别和免疫接种状态方面没有差异。14 名患者接受了白细胞减少治疗（交换输血[12]、白细胞去除[1]或两者[1]）。未明显观察到生存获益。
肺动脉高压可能与百日咳重症疾病的死亡率相关。白细胞计数升高与需要机械通气、肺动脉高压和死亡风险相关。需要开展研究以阐明肺动脉高压、免疫反应性和白细胞计数升高如何导致发病率和死亡率，以及白细胞减少治疗是否有效。
