Servicio de Medicina Intensiva, Hospital Universitario Doctor Peset, Valencia, Spain.
Servicio de Medicina Intensiva, Hospital Universitario Doctor Peset, Valencia, Spain.
Med Intensiva (Engl Ed). 2021 Aug-Sep;45(6):347-353. doi: 10.1016/j.medine.2019.11.007. Epub 2020 Apr 23.
To evaluate the risk factors associated to noninvasive mechanical ventilation (NIV) failure in patients with primary pneumonia due to influenza A (H1N1)pdm09 virus admitted to the intensive care unit (ICU), and to demonstrate the association of NIV failure to increased mortality and longer stays.
A cohort study was carried out.
A mixed ICU (16 beds) in a teaching hospital.
Adult patients admitted to the ICU with a diagnosis of pneumonia due to influenza A (H1N1)pdm09 virus requiring mechanical ventilation.
Age, sex, severity scores, administration of corticosteroids, oseltamivir within 72h of symptoms onset, days of symptoms prior to admission, affected quadrants, hemodynamic parameters, renal failure, laboratory test data on admission, mortality and stay in ICU and in hospital.
A total of 54 patients were admitted to the ICU and 49 were ventilated; 29 were females (59.2%), and the mean age±standard deviation was 66.77±14.77 years. Forty-three patients (87.75%) were ventilated with NIV, and 18 (41.9%) of them failed. Patients with NIV failure were younger (63 vs. 74 years; p=0.04), with a higher SOFA score (7 vs. 4; p=0.01) and greater early hemodynamic failure (61.1 vs. 8%; p=0.01). In addition, they presented longer ICU (26.28 vs. 6.88 days; p=0.01) and hospital stay (32.78 vs. 18.8 days; p=0.01). The ICU mortality rate was also higher in the NIV failure group (38.9 vs. 0%; p=0.02). In the multivariate analysis, corticosteroid therapy (OR 7.08; 95% CI 1.23-40.50) and early hemodynamic failure (OR 14.77; 95% CI 2.34-92.97) were identified as independent risk factors for NIV failure.
Treatment with corticosteroids and early hemodynamic failure were associated to NIV failure in patients with primary pneumonia due to influenza A (H1N1)pdm09 virus infection admitted to the ICU. The failure of NIV was associated to increased mortality.
评估因甲型流感 H1N1pdm09 病毒引起的原发性肺炎而入住重症监护病房（ICU）的患者接受无创机械通气（NIV）失败的相关危险因素，并证明 NIV 失败与死亡率增加和住院时间延长有关。
进行了一项队列研究。
一所教学医院的混合 ICU（16 张床）。
因甲型流感 H1N1pdm09 病毒引起的肺炎并需要机械通气而入住 ICU 的成年患者。
年龄、性别、严重程度评分、皮质类固醇的使用、症状出现后 72 小时内使用奥司他韦、症状出现前的天数、受影响的象限、血流动力学参数、肾功能衰竭、入院时的实验室检查数据、死亡率以及 ICU 和医院的住院时间。
共有 54 名患者入住 ICU，其中 49 名接受了通气治疗；29 名女性（59.2%），平均年龄±标准差为 66.77±14.77 岁。43 名患者（87.75%）接受了 NIV 通气治疗，其中 18 名（41.9%）失败。NIV 失败的患者更年轻（63 岁 vs. 74 岁；p=0.04），SOFA 评分更高（7 分 vs. 4 分；p=0.01），早期血流动力学衰竭更严重（61.1% vs. 8%；p=0.01）。此外，他们的 ICU 住院时间（26.28 天 vs. 6.88 天；p=0.01）和住院时间（32.78 天 vs. 18.8 天；p=0.01）也更长。NIV 失败组的 ICU 死亡率也更高（38.9% vs. 0%；p=0.02）。在多变量分析中，皮质类固醇治疗（OR 7.08；95%CI 1.23-40.50）和早期血流动力学衰竭（OR 14.77；95%CI 2.34-92.97）被确定为 NIV 失败的独立危险因素。
因甲型流感 H1N1pdm09 病毒感染而入住 ICU 的原发性肺炎患者接受皮质类固醇治疗和早期血流动力学衰竭与 NIV 失败相关。NIV 失败与死亡率增加有关。
