Department of Thoracic Medicine, Saint Paul's Hospital, Taoyuan, Taiwan; Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
J Formos Med Assoc. 2020 Jan;119(1 Pt 1):26-33. doi: 10.1016/j.jfma.2019.02.006. Epub 2019 Mar 7.
The incidence of acute respiratory distress syndrome (ARDS) and the mortality rate of H1N1 influenza pneumonia are unclear. The aim of this study is to investigate the clinical features and outcomes of adult patients admitted to intensive care units (ICUs) with H1N1 pneumonia related ARDS.
This retrospective study included patients with confirmed H1N1 influenza pneumonia admitted to the ICUs of a medical center between July 2009 and May 2014. We investigated the patients' characteristics, clinical presentations, illness severities, and outcomes.
Sixty-six patients were confirmed to have H1N1 influenza pneumonia requiring mechanical ventilation. Fifty-four of those patients (82%) developed ARDS, while their hospital mortality rate was 33% (22/66). There were no significant differences in the ICU and hospital mortality rates of the ARDS and non-ARDS patients. Among the ARDS patients, there were higher rates of solid malignant disease (22.8% vs. 2.8%, p = 0.038) and sepsis (66.7% vs. 33.3%, p = 0.020) and a higher mean tidal volume (8.9 ± 1.8 vs. 7.8 ± 1.9 ml/kg, p = 0.032) in the non-survivors than the survivors. Logistic regression analysis revealed that a high tidal volume (odds ratio = 1.448, 95 % CI = 1.033-2.030; p = 0.032) and sequential organ failure assessment (SOFA) score (odds ratio = 1.233, 95% CI = 1.029-1.478; p = 0.023) were the risk factors of hospital mortality.
For H1N1 influenza pneumonia patients admitted to ICUs with mechanical ventilation, there is a high probability of developing ARDS with a modest mortality rate. For patients with ARDS due to H1N1 influenza pneumonia, the tidal volume and SOFA score are the predictors of hospital mortality.
甲型 H1N1 流感肺炎所致急性呼吸窘迫综合征（ARDS）的发病率和死亡率尚不清楚。本研究旨在探讨入住重症监护病房（ICU）的甲型 H1N1 流感肺炎相关 ARDS 患者的临床特征和结局。
本回顾性研究纳入了 2009 年 7 月至 2014 年 5 月期间入住某医学中心 ICU 的确诊甲型 H1N1 流感肺炎患者。我们调查了患者的特征、临床表现、疾病严重程度和结局。
66 例患者确诊为需要机械通气的甲型 H1N1 流感肺炎。其中 54 例（82%）发展为 ARDS，其 ICU 死亡率和医院死亡率分别为 33%（22/66）和 33%（22/66）。ARDS 患者和非 ARDS 患者的 ICU 死亡率和医院死亡率无显著差异。在 ARDS 患者中，固体恶性肿瘤（22.8%比 2.8%，p=0.038）和脓毒症（66.7%比 33.3%，p=0.020）的发生率以及潮气量（8.9±1.8 ml/kg 比 7.8±1.9 ml/kg，p=0.032）均较高，非幸存者的死亡率高于幸存者。Logistic 回归分析显示，高潮气量（比值比=1.448，95%置信区间=1.033-2.030；p=0.032）和序贯器官衰竭评估（SOFA）评分（比值比=1.233，95%置信区间=1.029-1.478；p=0.023）是医院死亡率的危险因素。
对于入住 ICU 接受机械通气的甲型 H1N1 流感肺炎患者，发生 ARDS 的概率较高，死亡率适中。对于因甲型 H1N1 流感肺炎而发生 ARDS 的患者，潮气量和 SOFA 评分是预测医院死亡率的因素。
