Zatorski Paweł, Adamczyk Agata, Kosieradzki Maciej, Baczkowska Teresa, Kosson Dariusz, Trzebicki Janusz
Department of Teaching Anesthesiology and Intensive Therapy, Medical University of Warsaw, Warsaw, Poland.
First Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland.
Ann Transplant. 2018 Mar 30;23:218-223. doi: 10.12659/AOT.907083.
BACKGROUND In the general population, swine influenza is a self-limited infection. Patients after kidney transplantation, however, are at increased risk for complications and mortality from influenza A (H1N1). Acute respiratory distress syndrome (ARDS) complicates up to 55% of influenza-related pneumonia in hospitalized patients and carries a mortality of 40-46%. We describe our experience in intensive care of kidney transplant patients with ARDS complicating influenza A (H1N1) pneumonia during a flu outbreak. CASE REPORT Five adult post kidney transplantation patients with progressive respiratory failure admitted to the ICU between February 2016 and April 2016 were included in this retrospectively analysis. All patients had influenza A (H1N1) viral pneumonia (confirmed with RT-PCR) complicated by ARDS and septic shock with multiple organ dysfunction syndrome. None of the patients received seasonal influenza vaccines. All patients had negative rapid influenza bedside tests, which resulted in delay of administration of antiviral therapy prior to admission to the ICU. All patients were managed with a lung protective ventilation strategy (average days of mechanical ventilation, 17.6±15.3). Three patients required additional therapies for refractory hypoxemia, including high positive end-expiratory pressure and prone positioning. Extracorporeal membrane oxygenation was not implemented. Treatment with oseltamivir was added to a broad-spectrum antibiotic on the first to the fifth day of intensive care. Despite these measures, all patients eventually died. CONCLUSIONS Despite great progress in the management of ARDS, based mostly on advanced mechanical ventilation, early antiviral treatment of pneumonia caused by influenza A (H1N1) and annual vaccinations seem essential in prevention and management of influenza A (H1N1) infection among kidney transplant recipients.
背景 在普通人群中，猪流感是一种自限性感染。然而，肾移植患者发生甲型H1N1流感并发症和死亡的风险增加。急性呼吸窘迫综合征（ARDS）使住院患者中高达55%的流感相关肺炎复杂化，死亡率为40% - 46%。我们描述了在流感暴发期间对并发甲型H1N1流感肺炎的ARDS肾移植患者进行重症监护的经验。病例报告 本回顾性分析纳入了2016年2月至2016年4月间入住重症监护病房（ICU）的5例成年肾移植后进行性呼吸衰竭患者。所有患者均患有甲型H1N1病毒性肺炎（经逆转录聚合酶链反应（RT-PCR）确诊），并发ARDS和感染性休克伴多器官功能障碍综合征。所有患者均未接种季节性流感疫苗。所有患者床边快速流感检测均为阴性，这导致在入住ICU前抗病毒治疗延迟。所有患者均采用肺保护性通气策略（机械通气平均天数为17.6±15.3天）。3例患者因难治性低氧血症需要额外治疗，包括高呼气末正压和俯卧位通气。未实施体外膜肺氧合。在重症监护的第1天至第5天，在广谱抗生素基础上加用了奥司他韦治疗。尽管采取了这些措施，所有患者最终均死亡。结论 尽管在ARDS的管理方面取得了很大进展，主要基于先进的机械通气，但对甲型H1N1流感引起的肺炎进行早期抗病毒治疗以及每年接种疫苗似乎对于预防和管理肾移植受者中的甲型H1N1感染至关重要。
