Golagana Vinya, Venkataraman Ramesh, Mani Ashwin K, Rajan Ebenezer Rabindra, Ramakrishnan Nagarajan, Vidyasagar Dedeepiya Devaprasad
Department of Critical Care Medicine, Apollo Hospitals, Hyderabad, Telangana, India.
Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India.
Indian J Crit Care Med. 2023 Jul;27(7):470-474. doi: 10.5005/jp-journals-10071-24493.
Pandemic influenza H1N1/09 emerged for the first time in April 2009 and has spread widely across India since then. The number of cases have increased over time with the increasing need for respiratory support, causing significant morbidity and mortality. We evaluated the clinical course and outcomes of patients infected with Influenza A (H1N1) admitted to three multidisciplinary intensive care units (ICU) in Chennai.
We performed a combined retrospective and prospective observational study of all patients admitted with H1N1 pneumonia at three multidisciplinary ICUs in Chennai from October 1, 2018, to January 31, 2019. Data including demographics, risk factors, and clinical courses were recorded. Outcome data including mortality was tracked up to 28 days.
A total of 167 patients were admitted during the study period of which 154 were included in this analysis. The mean age of presentation was 58.2 ± 15.6 years and 59.1% of them were males. The mean acute physiology and chronic health evaluation (APACHE) IV and sequential organ failure assessment (SOFA) scores were 62.8 ± 23.2 and 5.8 ± 3.9 respectively. Oxygen delivery devices were required in 25.3% for a mean duration of 26.5 ± 5.7 hours. Non-invasive ventilation or high-flow nasal cannula (HFNC) was needed in 33.1% of patients for 59.9 ± 64.5 hours. The proportion of patients requiring mechanical ventilation was 41.6%. Rescue measures in the form of proning, use of inhaled nitric oxide (iNO), and extracorporeal membrane oxygenation (ECMO) were initiated for refractory hypoxemia in 26.6%, 14.1%, and 6.3% respectively. The mean duration of ventilator support was 8.5 ± 8 days. Tracheostomy was required in 20.3% of patients and 7.8% were ventilator dependent at 28 days. The mean ICU and Hospital length of stay were 8.3 ± 10.3 and 12.2 ± 14.1 days respectively and overall 28-day mortality was 20.1%.
A significant proportion of H1N1 patients admitted to the ICU required high-level respiratory support including non-invasive ventilation (NIV), HFNC, or invasive ventilation. Deployment of rescue therapies was common and the overall mortality rate was similar to those reported from Western countries.
Golagana V, Venkataraman R, Mani AK, Rajan ER, Ramakrishnan N, Vidyasagar DD. Epidemiology and Outcomes of HIN1 Pneumonia in ICU. Indian J Crit Care Med 2023;27(7):470-474.
2009年4月首次出现甲型H1N1流感大流行，自那时起已在印度广泛传播。随着对呼吸支持需求的增加，病例数随时间上升，导致了显著的发病率和死亡率。我们评估了钦奈三家多学科重症监护病房（ICU）收治的甲型H1N1流感感染患者的临床病程和结局。
我们对2018年10月1日至2019年1月31日期间在钦奈三家多学科ICU收治的所有甲型H1N1流感肺炎患者进行了回顾性和前瞻性联合观察研究。记录了包括人口统计学、危险因素和临床病程等数据。追踪结局数据包括死亡率至28天。
研究期间共收治167例患者，本分析纳入其中154例。就诊时的平均年龄为58.2±15.6岁，其中59.1%为男性。急性生理与慢性健康评估（APACHE）IV评分和序贯器官衰竭评估（SOFA）评分的平均值分别为62.8±23.2和5.8±3.9。25.3%的患者需要氧气输送设备，平均持续时间为26.5±5.7小时。33.1%的患者需要无创通气或高流量鼻导管（HFNC），持续时间为59.9±64.5小时。需要机械通气的患者比例为41.6%。对于难治性低氧血症，分别有26.6%、14.1%和6.3%的患者采取了俯卧位通气、吸入一氧化氮（iNO）和体外膜肺氧合（ECMO）等抢救措施。机械通气支持的平均持续时间为8.5±8天。20.3%的患者需要气管切开，28天时7.8%的患者依赖呼吸机。ICU平均住院时间和医院平均住院时间分别为8.3±10.3天和12.2±14.1天，总体28天死亡率为20.1%。
入住ICU的甲型H1N1流感患者中有很大一部分需要高水平的呼吸支持，包括无创通气（NIV）、HFNC或有创通气。抢救治疗的应用很常见，总体死亡率与西方国家报道的相似。
Golagana V, Venkataraman R, Mani AK, Rajan ER, Ramakrishnan N, Vidyasagar DD. ICU中HIN1肺炎的流行病学和结局。《印度重症监护医学杂志》2023；27(7):470 - 474。
