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镇静镇痛肌松文献: 1、Pulmonary sequelae of severe H1N1 infection treated with high frequency oscillatory ventilation. 机器翻译 作者: Edgeworth D;Brohan J;O'Neill S;Maher M;Breen D;Murphy D ; 出处: Ir Med J.2013V106N8 :249-52 联系地址: Cork University Hospital, Wilton, Cork. [email protected]## ISSN: 0332-3102 (Print)0332-3102 (Linking) 摘要: During the recent influenza A (H1N1) pandemic, due to severe respiratory failure many patients required treatment with alternative ventilator modalities including High Frequency Oscillatory Ventilation (HFOV). We present four such patients treated with HFOV at an academic, tertiary referral hospital in Ireland. We detail outcomes of clinical examination, pulmonary function testing, quality of life assessment and radiographic appearance on CT Thorax at follow-up at 6 months. Further clinical assessment and pulmonary function testing were performed at median 19 months (range 18-21 months) post-discharge. At initial review all patients were found to have reduced gas transfer (median predicted DLCO 74%) with preservation of lung volumes and normal spirometrical values at 6 months (median FVC 5.42L [101% predicted] and FEV14.5L [101.2% predicted] respectively), with improvements in gas transfer (median predicted DLCO 83%)at subsequent testing. Post-inflammatory changes on CT thorax at 6 months were seen in all 4 cases. To our knowledge this is the first report to document the long-term effects of severe H1N1 infection requiring high frequency oscillation on respiratory function. We conclude that the effects on respiratory function and pulmonary radiological appearance are similar to those observed following conventional treatment of Acute Respiratory Distress Syndrome [ARDS]. Adult 【成年人】 Female 【女(雌)性】 Follow-Up Studies 【随访研究】 Forced Expiratory Volume 【用力呼气量】 *High-Frequency Ventilation/methods 【*高频通气/方法】 Hospitals, University 【医院, 大学】 Humans 【人类】 Influenza A Virus, H1N1 Subtype/*isolation & purification 【*流感病毒 A 型,H1N1 亚型】 Influenza, Human/*complications/virology 【*流感, 人类/*并发症/病毒学】 Ireland 【爱尔兰】 Male 【男(雄)性】 Middle Aged 【中年人】 Pneumothorax/virology 【气胸/病毒学】 Quality of Life 【生活质量】 Respiratory Insufficiency/complications/*diagnosis/physiopathology/radiography/*therapy/vir ol ogy 【*呼吸功能不全/并发症/*诊断/病理生理学/放射摄影术/*治疗】 Risk Factors 【危险因素】 Severity of Illness Index 【疾病严重程度指数】 Spirometry 【肺量测定法】 Treatment Outcome 【治疗结果】 2、 Effectiveness and predictors of success of noninvasive ventilation during H1N1 pandemics: a multicenter study. 机器翻译 作者: Nicolini A;Tonveronachi E;Navalesi P;Antonelli M; Valentini I;Melotti RM;Pigna A;Carrassi A;Righini P; Ferrari Bravo M;Pelosi P;Nicoli F;Cosentini R;Vaschetto R;Faenza S;Nava S ; 出处: Minerva Anestesiol.2012V78N12 :1333-40 [IF:2.818] 联系地址: Respiratory Diseases Unit, Hospital of Sestri Levante, Sestri Levante, Genoa, Italy.## ISSN: 1827-1596 (Electronic)0375-9393 (Linking) 结论: The early application of NIV, with the aim to avoid invasive ventilation, during the H1N1 pandemics was associated with an overall success rate of 47/98 (48%). Patients presenting at admission with an high SAPS II score and a low PaO2/FiO2 ratio and/or unable to promptly correct gas exchange are at high risk of intubation and mortality. 机器翻译 摘要: BACKGROUND: The use of non-invasive ventilation (NIV) in acute hypoxemic respiratory failure (AHRF) due to H1N1 virus infection is controversial. In this multicenter study we aimed to assess the efficacy of NIV in avoiding endotracheal intubation (ETI) and to identify predictors of success or failure. METHODS: In this prospective multicenter study, 98 patients with new pulmonary infiltrate(s) sustained by H1N1 virus and a PaO(2)/FiO2<300 were eligible for study; 38/98 required immediate ETI, while the others received NIV as a first line therapy; 13/60 patients failed NIV and were intubated after 5.8+5.5 hours from enrolment. The remaining 47/60 patients were successfully ventilated with NIV. RESULTS: Hospital mortality was significantly higher in those patients who failed NIV vs. those who succeeded (53.8% vs. 2.1%; OR=0.52, P<0.001). ETI was associated with higher number of infectious complications, mainly sepsis and septic shock. The OR of having one of these events in the NIV failure group vs. NIV success was 16.7, P<0.001. According to logistic regression model, a SAPS II>29 and a PaO(2)/FIO(2)at admission and PaO2/FIO(2)after 1 hr of NIV were independently associated with the need for ETI. CONCLUSION: The early application of NIV, with the aim to avoid invasive ventilation, during the H1N1 pandemics was associated with an overall success rate of 47/98 (48%). Patients presenting at admission with an high SAPS II score and a low PaO(2)/FiO(2) ratio and/or unable to promptly correct gas exchange are at high risk of intubation and mortality. 3、 Experience with high frequency oscillation ventilation during the 2009 H1N1 influenza pandemic in Australia and New Zealand. 机器翻译 作者: Boots RJ;Lipman J;Lassig-Smith M;Stephens DP;Thomas J;Shehabi Y;Bass F;Anthony A;Long D;Seppelt IM;Weisbrodt L;Erickson S;Beca J;Sherring C;McGuiness S;Parke R; Stachowski ER;Boyd R;Howet B ; 出处: Anaesth Intensive Care.2011V39N5 :837-46 1.279] [IF: 联系地址: Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland.## ISSN: 0310-057X (Print)0310-057X (Linking) 结论: Overall hospital survival was 77% in H1N1 patients, while survival in patients having adjunctive extracorporeal membrane oxygenation was similar to those receiving high frequency oscillation ventilation alone (65% compared to 71%, P = 1.00). High frequency oscillation ventilation was used successfully as a rescue therapy for severe respiratory failure. High frequency oscillation ventilation was only available in a limited number of intensive care units during the H1N1 pandemic. 机器翻译 摘要: During the 2009 H1N1 pandemic, large numbers of patients had severe respiratory failure. High frequency oscillation ventilation was used as a salvage technique for profound hypoxaemia. Our aim was to compare this experience with high frequency oscillation ventilation during the 2009 H1N1 pandemic with the same period in 2008 by performing a three-month period prevalence study in Australian and New Zealand intensive care units. The main study end-points were clinical demographics, care delivery and survival. Nine intensive care units contributed data. During 2009 there were 22 H1N1 patients (17 adults, five children) and 10 non-H1N1 patients ( five adults, five children), while in 2008, 18 patients (two adults, 16 children) received high frequency oscillation ventilation. The principal non-H1N1 high frequency oscillation ventilation indication was bacterial or viral pneumonia (56%). For H1N1 patients, the median duration of high frequency oscillation ventilation was 3.7 days ( interquartile range 1.8 to 5) with concomitant therapies including recruitment manoeuvres (22%), prone ventilation (41%), inhaled prostacyclins (18%) and inhaled nitric oxide (36%). Seven patients received extracorporeal membrane oxygenation, six having H1N1. Three patients had extracorporeal membrane oxygenation concurrently, two as salvage therapy following the commencement of high frequency oscillation ventilation. In 2008, no high frequency oscillation ventilation patient received extracorporeal membrane oxygenation. Overall hospital survival was 77% in H1N1 patients, while survival in patients having adjunctive extracorporeal membrane oxygenation was similar to those receiving high frequency oscillation ventilation alone (65% compared to 71%, P = 1.00). Survival rates were comparable to published extracorporeal membrane oxygenation outcomes. High frequency oscillation ventilation was used successfully as a rescue therapy for severe respiratory failure. High frequency oscillation ventilation was only available in a limited number of intensive care units during the H1N1 pandemic. 机器翻译 语种: eng 4、 [ Mechanical ventilation in patients with most severe forms of influenza A H1N1]. 机器翻译 作者: Romic P;Nozic D;Surbatovic M;Veljovic M; Stojic M;Vukovic R ; 出处: Vojnosanit Pregl.2011V68N3 :235-40 0.179] [IF: 联系地址: Vojnomedicinska akademija, Klinika za anesteziologiju i intenzivnu terapiju, Beograd, Srbija.## ISSN: 0042-8450 (Print)0042-8450 (Linking) 结论: Intensive therapy of patients with ARDS due to A H1N1 influenza virus requires MV which should be carried out according to guidelines of international expert forums. That is in accordance with our unexpected observation on negative correlation between duration of MV and fatal outcome. Intensive treatment of these patients, specially MV, can be very prolonged and, therefore, requires specialized teams of anesthesiologists, separate, isolated intensive therapy units and high level of medical staff protection, as was the case in this study, so no member of medical staff was infected. 机器翻译 摘要: BACKGROUND/ AIM: Pandemic of A H1N1 influenza is noted for its rapid spreading and life-threatening consequences like acute respiratory distress syndrome (ARDS) which requires mechanical ventilation (MV) and intensive therapy (IT).The aim of the study was to determine the significance of mechanical ventilation application in the presence of comorbidities on the outcome of the disease and patients with severe forms of acute influenza caused by A H1N1 virus. METHODS: Five patients with acute respiratory failure caused by A H1N1 influenza that required MV were included in the study. Course and outcome of the treatment were monitored in relation to age and sex of the patients, concomitant diseases, time of influenza beginning, a time of admittance in an intensive care unit, a time of an endotracheal intubation and MV beginning, MV duration and occurrence of secondary infections. RESULTS: Three patients were on a very prolonged MV (39, 43 and 20 days, respectively) and they all survived. Two patients with a significantly shorter duration of MV (14 and 12 days, respectively) died because of a very severe clinical course and concomitant diseases. Unexpectedly, we found a positive correlation between duration of MV and survival although two patients, who were on MV for the longest period of time (43 and 39 days, respectively), developed, as a complication, secondary bacterial pneumonia. CONCLUSION: Intensive therapy of patients with ARDS due to A H1N1 influenza virus requires MV which should be carried out according to guidelines of international expert forums. That is in accordance with our unexpected observation on negative correlation between duration of MV and fatal outcome. Intensive treatment of these patients, specially MV, can be very prolonged and, therefore, requires specialized teams of anesthesiologists, separate, isolated intensive therapy units and high level of medical staff protection, as was the case in this study, so no member of medical staff was infected. 5、 Triage of mechanical ventilation for pediatric patients during a pandemic. 机器翻译 作者: Kim KM;Cinti S;Gay S;Goold S;Barnosky A; Lozon M ; 出处: Disaster Med Public Health Prep.2012V6N2 :131-7 [IF:1.141] 联系地址: University of Michigan Health System, Ann Arbor, Michigan, USA. [email protected]## ISSN: 1938-744X (Electronic)1935-7893 (Linking) 摘要: OBJECTIVE: The novel H1N1 influenza pandemic renewed the concern that during a severe pandemic illness, critical care and mechanical ventilation resources will be inadequate to meet the needs of patients. Several published protocols address the need to triage patients for access to ventilator resources. However, to our knowledge, none of these has addressed the pediatric populations. METHODS: We used a systematic review of the pediatric critical care literature to evaluate pediatric critical care prognosis and multisystem organ failure scoring systems. We used multiple search engines, including MEDLINE and EMBASE, using a search for terms and key words including including multiple organ failure, multiple organ dysfunction, PELOD, PRISM III, pediatric risk of mortality score, pediatric logistic organ dysfunction, pediatric index of mortality pediatric multiple organ dysfunction score, "child+ multiple organ failure + scoring system." Searches were conducted in the period January 2010-February 2010. RESULTS: Of the 69 papers reviewed, 22 were used. Five independently derived scoring systems were evaluated for use in a respiratory pandemic ventilator triage protocol. The Pediatric Logistic Organ Dysfunction (PELOD) scoring system was the most appropriate for use in such a triage protocol. CONCLUSIONS: We present a pediatric-specific ventilator triage protocol using the PELOD scoring system to complement the NY State adult triage protocol. Further evaluation of pediatric scoring systems is imperative to ensure appropriate triage of pediatric patients. 机器翻译 6、 Should we "rescue" patients with 2009 influenza A(H1N1) and lung injury from conventional mechanical ventilation? 机器翻译 作者: Hubmayr RD;Farmer JC ; 出处: Chest.2010V137N4 :745-7 6.519] [IF: ISSN: 1931-3543 (Electronic)0012-3692 (Linking) 语种: eng 出版国: United States 文献类型: Comment;Editorial; 主题词: Acute Lung Injury/*therapy/*virology 【急性肺损伤/治疗/病毒学】 Extracorporeal Membrane Oxygenation 【体外膜氧合作用】 *High-Frequency Ventilation 【High-Frequency Ventilation】 Humans 【人类】 *Influenza A Virus, H1N1 Subtype 【Influenza A Virus, H1N1 Subtype】 Influenza, Human/*complications 【流感,人类/治疗/病毒学并发症】 Respiratory Distress Syndrome, Adult/therapy/virology 【呼吸窘迫综合 征, 成人/治疗/病毒学并发症治疗/病毒学】 7、 Haemofiltration and high-frequency oscillatory ventilation in H1N1-induced acute respiratory distress syndrome. 机器翻译 作者: Fitzgerald M;Desmond F;Breen D ; 出处: Crit Care Resusc.2012V14N1 :88 [IF:1.507] ISSN: 1441-2772 (Print)1441-2772 (Linking) 语种: eng 出版国: Australia 文献类型: Letter; 主题词: Acute Kidney Injury/blood/*therapy/*virology 【* 急性肾损伤/血液/*治疗/*病毒学】 *Hemofiltration 【*血液滤过】 *High-Frequency Ventilation 【*高频 通气】 Humans 【人类】 Influenza A Virus, H1N1 Subtype/*isolation & purification 【* 流感病毒 A 型,H1N1 亚型】 Influenza, Human/blood/*therapy/virology 【*流 感, 人类/血液/*治疗/病毒学】 Respiratory Distress Syndrome, Adult/blood/*therapy/virology 【*呼 吸窘迫综合征, 成人/血液/*治疗/病毒 学】 Risk factors for mechanical ventilation in U.S. children hospitalized with seasonal influenza and 2009 pandemic influenza A*. 机器翻译 作者: Eriksson CO;Graham DA;Uyeki TM; Randolph AG ; 出处: Pediatr Crit Care Med.2012V13N6 :625-31 2.354] [IF: 联系地址: Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.## ISSN: 1529-7535 (Print)1529-7535 (Linking) 结论: : Although the number of children with a hospital discharge diagnosis of influenza almost tripled during the 2009 pandemic influenza A period, the risk- adjusted proportion of children receiving mechanical ventilation was lower than we would have predicted in a seasonal influenza cohort. Early hospital use of influenza antiviral medications was associated with a decrease in late-onset mechanical ventilation. 机器翻译 摘要: OBJECTIVE: We tested the hypothesis that the use of mechanical ventilator support in children hospitalized with influenza during the 2009 H1N1 influenza A (H1N1) pandemic was higher than would be expected in children hospitalized for seasonal influenza after adjusting for patient risk. DESIGN: Retrospective cohort study. SETTING: Forty-three U.S. pediatric hospitals. PATIENTS: Children <18 yrs old with a discharge diagnosis of influenza admitted July 2006 through March 2009 (seasonal influenza) and June through December 2009 (2009 pandemic influenza A). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We included 10,173 children hospitalized with seasonal influenza and 9837 with presumed 2009 pandemic influenza A. The 2009 pandemic influenza A cohort was older (median 5.0 vs. 1.9 yrs), more likely to have asthma (30% vs. 18%), and less likely to receive mechanical ventilation (7.1% [n = 701] vs. 9.2% [n = 940]). Using logistic regression, we created a multivariable model of risk factors associated with endotracheal mechanical ventilator support in the seasonal influenza cohort and used this model to predict the number of expected mechanical ventilation cases in children with presumed 2009 pandemic influenza A. Adjusted for underlying health conditions, race, age, and a co-diagnosis of bacterial pneumonia, the observed/expected rate of mechanical ventilation in the presumed 2009 pandemic influenza A cohort was 0.74 (95% confidence interval 0.68-0.79). Early hospital treatment with influenza antiviral medications was associated with decreased initiation of mechanical ventilation on hospital day >/= 3 in the seasonal influenza (odds ratio 0.66; 95% confidence interval 0.45-0.97) and 2009 pandemic influenza A (odds ratio 0.23; 95% confidence interval 0.16-0.34) periods; influenza antiviral use in the 2009 pandemic influenza A period was much higher (70% vs. 20%; p < .001). CONCLUSIONS: Although the number of children with a hospital discharge diagnosis of influenza almost tripled during the 2009 pandemic influenza A period, the risk- adjusted proportion of children receiving mechanical ventilation was lower than we would have predicted in a seasonal influenza cohort. Early hospital use of influenza antiviral medications was associated with a decrease in late-onset mechanical ventilation. 8、 Successful use of venovenous extracorporeal membrane oxygenation for complicated H1N1 pneumonia refractory to mechanical ventilation. 机器翻译 作者: Patel SA;DeMare JS;Truemper EJ; Deptula JJ ; 出处: J Extra Corpor Technol.2011V43N2 :70-4 联系地址: Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska 68198-2185, USA. [email protected]## ISSN: 0022-1058 (Print)0022-1058 (Linking) 结论: We report the successful use of VV ECMO in two children with confirmed novel H1N1 complicated by bacterial pneumonia or morbid obesity. Prompt initiation of VV ECMO resulted in rapid clinical improvement, radiographic resolution of diffuse consolidation, and return of full neurocognitive function. For children with rapidly progressive respiratory distress on conventional ventilation, VV ECMO can be used to improve outcomes when initiated early in the disease process even in children with a significant co- morbidity. 机器翻译 摘要: In April 2009, novel H1N1 influenza A pneumonia was initially identified in young adults by the Mexican Health Ministry. Previously healthy patients progressing to multisystem organ failure were common. Worldwide, hospitals reported surges in intensive care admissions during the initial phase of the pandemic. In patients with H1N1 pneumonia refractory to mechanical ventilation, centers were initially reporting low survival rates despite the use of extracorporeal membrane oxygenation (ECMO). The initial poor outcomes and protracted ECMO treatment epochs resulted in centers limiting or withholding the use of ECMO in this population. With respect to children with H1N1 infection there was uncertainty concerning optimal incorporation of ECMO as a therapeutic option. In children with rapidly progressive pneumonia and hypoxia refractory to mechanical ventilation, venovenous (VV) ECMO has been successfully used with survival ranging from 40-60% depending on the etiology. We report the successful use of VV ECMO in two children with confirmed novel H1N1 complicated by bacterial pneumonia or morbid obesity. Our Institutional Review Board waived the need for consent. Prompt initiation of VV ECMO resulted in rapid clinical improvement, radiographic resolution of diffuse consolidation, and return of full neurocognitive function. For children with rapidly progressive respiratory distress on conventional ventilation, VV ECMO can be used to improve outcomes when initiated early in the disease process even in children with a significant co- morbidity. 9、 [42-year- old obese man with H1N1 influenza A infection necessitating mechanical ventilation]. 机器翻译 作者: Daneschwar F;Tschudin Sutter S;Widmer AF;Battegay M ; 出处: Internist (Berl).2010V51N10 :1308-10, 1312 [IF:0.348] 联系地址: Klinikum Lichtenfels, Medizinische Klinik, Lichtenfels, Deutschland. [email protected]## ISSN: 1432-1289 (Electronic)0020-9554 (Linking) 结论: A 42-year- old obese patient was admitted to our hospital due to dyspnoea and high fever. A/H1N1v-infection was diagnosed after no causative agent could be detected initially. The patient's condition improved under oseltamivir, which was administered over ten days. 机器翻译 摘要: A 42-year- old obese patient was admitted to our hospital due to dyspnoea and high fever. He was diagnosed with pneumonia, which progressed rapidly, so that he had to be transferred to the intensive care unit for mechanical ventilation. A/H1N1v-infection was diagnosed after no causative agent could be detected initially. The patient's condition improved under oseltamivir, which was administered over ten days. 10、 Pandemic 2009 influenza A in Argentina: a study of 337 patients on mechanical ventilation. 机器翻译 作者: Estenssoro E;Rios FG;Apezteguia C;Reina R;Neira J; Ceraso DH;Orlandi C;Valentini R;Tiribelli N;Brizuela M;Balasini C;Mare S;Domeniconi G;Ilutovich S;Gomez A; Giuliani J;Barrios C;Valdez P ; 出处: Am J Respir Crit Care Med.2010V182N1 :41-8 10.191] [IF: 联系地址: Servicio de Terapia Intensiva, Hospital Interzonal de Agudos San Martin de La Plata, La Plata, Buenos Aires, Argentina. [email protected]## ISSN: 1535-4970 (Electronic)1073-449X (Linking) 结论: The rapid spread of the 2009 Influenza A (H1N1) around the world underscores the need for a better knowledge of epidemiology, clinical features, outcomes, and mortality predictors, especially in the most severe presentations. To describe these characteristics in patients with confirmed, probable, and suspected viral pneumonia caused by 2009 influenza A (H1N1) admitted to 35 intensive care units with acute respiratory failure requiring mechanical ventilation in Argentina, between June 3 and September 7. Inception-cohort study including 337 consecutive adult patients. APACHE II, lowest Pa(O(2))/Fi(O(2)), shock, hemodialysis, prone positioning, and S. pneumoniae coinfection independently predicted death. Patients with 2009 influenza A (H1N1) requiring mechanical ventilation were mostly middle-aged adults, often with comorbidities, and frequently developed severe acute respiratory distress syndrome and multiorgan failure requiring advanced organ support. Case fatality rate was accordingly high. 机器翻译 摘要: RATIONALE: The rapid spread of the 2009 Influenza A (H1N1) around the world underscores the need for a better knowledge of epidemiology, clinical features, outcomes, and mortality predictors, especially in the most severe presentations. OBJECTIVES: To describe these characteristics in patients with confirmed, probable, and suspected viral pneumonia caused by 2009 influenza A (H1N1) admitted to 35 intensive care units with acute respiratory failure requiring mechanical ventilation in Argentina, between June 3 and September 7. METHODS: Inception-cohort study including 337 consecutive adult patients. Data were collected in a form posted on the Argentinian Society of Intensive Care website. MEASUREMENTS AND MAIN RESULTS: Proportions of confirmed, probable, or suspected cases were 39%, 8%, and 53% and had similar outcomes. APACHE II was 18 +/-7; age 47 +/-17 years; 56% were male; and 64% had underlying conditions, with obesity (24%), chronic obstructive respiratory disease (18%), and immunosupression (15%) being the most common. Seven percent were pregnant. On admission, patients had severe hypoxemia (Pa(O(2))/Fi(O(2)) 140 [87-200]), extensive lung radiologic infiltrates (2.87 +/-1.03 quadrants) and bacterial coinfection, (25%; mostly with Streptococcus pneumoniae). Use of adjuvants such as recruitment maneuvers (40%) and prone positioning (13%), and shock (72%) and acute kidney injury requiring hemodialysis (17%), were frequent. Mortality was 46%, and was similar across all ages. APACHE II, lowest Pa(O(2))/Fi(O(2)), shock, hemodialysis, prone positioning, and S. pneumoniae coinfection independently predicted death. CONCLUSIONS: Patients with 2009 influenza A (H1N1) requiring mechanical ventilation were mostly middle-aged adults, often with comorbidities, and frequently developed severe acute respiratory distress syndrome and multiorgan failure requiring advanced organ support. Case fatality rate was accordingly high. 机器翻译 11、 Early application of high frequency oscillatory ventilation in 'H1N1 influenza' related ARDS is associated with better outcome: a retrospective study. 机器翻译 作者: Jog S;Patel D;Dravid T;Rajhans P;Akole P;Pawar B;Kothari M;Bhurke B;Deshpande A ; 出处: Intensive Care Med.2013V39N6 :1146-7 [IF:5.544] 12、 Early clinical characteristics and pregnancy outcomes of patients with influenza A (H1N1) infection requiring mechanical ventilation during pregnancy. 机器翻译 作者: Chang C;Gao HL;Yao WZ;Gao H;Cui Y ; 出处: J Obstet Gynaecol.2013V33N6 :561-5 0.604] [IF: 联系地址: Department of Respiratory Medicine, The Third Hospital of Peking University, Beijing, China.## ISSN: 1364-6893 (Electronic)0144-3615 (Linking) 摘要: The early clinical characteristics and pregnancy outcomes of H1N1-infected pregnant women with or without mechanical ventilation were compared. In H1N1-infected pregnant women with mechanical ventilation, the gestational age was greater, the early oxygenation index was lower and early-stage pneumonic lesions were wider than patients without mechanical ventilation. Moreover, compared with the non- mechanical ventilation group, the incidence of the adverse pregnancy outcomes was higher in the mechanical ventilation group. 13、 A discussion about the tactics of mechanical ventilation for acute respiratory distress occurring in the first case of influenza A (H5N1) in Guizhou Province]. 机器翻译 作者: Liu L;Sun ZL;Wang JY;Zhang XY;Feng DX;Cai YC;Liu WJ;Hu YD;Zhang GP; Ji CL;Ye BN;Wang YH;Li C ; 出处: Zhongguo Wei Zhong Bing Ji Jiu Yi Xue.2009V21N4 :237-9 联系地址: Department of Intensive Care Unit, People's Hospital of Guizhou Province, Guiyang 550002, Guizhou, China. [email protected]## ISSN: 1003-0603 (Print)1003-0603 (Linking) 摘要: OBJECTIVE: To discuss the tactics of mechanical ventilation in a human severe case of influenza A (H5N1) complicated with acute respiratory distress syndrome (ARDS). METHODS: The data of the patient infected by the influenza A (H5N1) admitted to People's Hospital of Guizhou Province on January 15, 2009, were analyzed and summarized. RESULTS: The patient, a 29-year- old man, had been healthy in the past, but had exposed to the environment of bird flu before illness. The initial symptom was unremitting high fever, and then the clinical situation deteriorated progressively with occurrence of dyspnea. Pulmonary infiltrates were evident in the left lower lobe on January 19, and rapidly progressed to involve bilateral lungs presenting ARDS-like changes. Mechanical ventilation became the most important treatment among others. The ventilation mode was synchronized intermittent mandatory ventilation (SIMV)+ pressure support (PS) + positive end expiratory pressure (PEEP), following lung protective ventilatory strategies, with low tidal volume. The patient's condition improved day by day without developing multiple organ dysfunction. The patient fully recovered and was discharged on February 6. CONCLUSION: Early detection, early diagnosis, and finely effective intervention are to improve oxygenation by mechanical ventilation with low tidal volume and adequate PEEP are critical to reducing the mortality. 14、 Clinical characteristics and outcomes of patients with 2009 influenza A(H1N1) virus infection with respiratory failure requiring mechanical ventilation. 机器翻译 作者: Nin N;Soto L;Hurtado J;Lorente JA;Buroni M; Arancibia F;Ugarte S;Bagnulo H;Cardinal P;Bugedo G;Echevarria E;Deicas A;Ortega C;Frutos-Vivar F;Esteban A ; 出处: J Crit Care.2011V26N2 :186-92 [IF:2.134] 联系地址: Hospital Universitario de Getafe & CIBER de Enfermedades Respiratorias, Madrid, Spain.## ISSN: 1557-8615 (Electronic)0883-9441 (Linking) 结论: Patients with 2009 influenza A(H1N1) and respiratory failure requiring mechanical ventilation often present with clinical criteria of acute respiratory distress syndrome and shock. Bacterial pneumonia is a frequent complication. Mortality is high and is primarily due to refractory hypoxia. 机器翻译 摘要: PURPOSE: The purpose of the study was to describe the clinical characteristics and outcomes of critically ill patients with 2009 influenza A(H1N1). METHODS: An observational study of patients with confirmed or probable 2009 influenza A(H1N1) and respiratory failure requiring mechanical ventilation was performed. RESULTS: We studied 96 patients (mean age, 45 [14] years [mean, SD]; 44% female). Shock and acute respiratory distress syndrome were diagnosed during the first 72 hours of admission in 43% and 72% of patients, respectively. Noninvasive positive pressure ventilation was used in 45% of the patients, but failed in 77% of them. Bacterial pneumonia was diagnosed in 33% of cases, 8% during the first week ( due to community-acquired microorganisms) and 25% after the first week ( due to gram-negative bacilli and resistant gram-positive cocci). Intensive care unit mortality was 50%. Nonsurvivors differed from survivors in the prevalence of cardiovascular, respiratory, and hematologic failure on admission and late pneumonia. Reported causes of death were refractory hypoxia, multiorgan failure, and shock (50%, 38%, and 12% of all causes of death, respectively). CONCLUSIONS: Patients with 2009 influenza A(H1N1) and respiratory failure requiring mechanical ventilation often present with clinical criteria of acute respiratory distress syndrome and shock. Bacterial pneumonia is a frequent complication. Mortality is high and is primarily due to refractory hypoxia. 15、 Clinical course of ICU patients with severe pandemic 2009 influenza A (H1N1) pneumonia: single center experience with proning and pressure release ventilation. 机器翻译 作者: Sundar KM;Thaut P;Nielsen DB; Alward WT;Pearce MJ ; 出处: J Intensive Care Med.2012V27N3 :184-90 联系地址: Department of Medicine, Utah Valley Regional Medical Center, Provo, UT 84604, USA. [email protected]## ISSN: 1525-1489 (Electronic)0885-0666 (Linking) 结论: Proning in combination with APRV provides improvement of hypoxemia with limitation of end-organ dysfunction and thereby facilitates recovery from severe 2009 pandemic influenza A (H1N1). 机器翻译 摘要: BACKGROUND: A number of different modalities have been employed in addition to conventional ventilation to improve oxygenation in patients with severe 2009 pandemic influenza A (H1N1) pneumonia. Outcomes with ventilatory and rescue therapies for H1N1 influenza-related acute respiratory distress syndrome (ARDS) have been varied. A single intensive care unit (ICU) experience with management of laboratory-confirmed 2009 pandemic influenza A (H1N1) ARDS with a combination of proning and airway pressure release ventilation (APRV) is described. METHODS: A retrospective review of medical records of ICU patients seen at Utah Valley Regional Medical Center during the first and second waves of the H1N1 influenza pandemic was done. RESULTS: Fourteen ICU patients were managed with invasive ventilation for 2009 pandemic influenza A (H1N1)-related ARDS. Hypoxemia refractory to conventional ventilation was noted in 11 of 14 patients despite application of APRV. Following proning in patients on APRV, improvement of hypoxemia and hemodynamic status was achieved. Only 2 of 11 patients on APRV and proning required continuous dialysis. Mortality in intubated patients receiving a combination of proning and APRV was 27.3% (3/11) with 2 of these dying during the first wave of the H1N1 influenza pandemic. In all, 3 of 11 patients on proning and APRV underwent tracheostomy, with 2 of these undergoing tube thoracostomy. ARDSnet fluid- conservative protocol was safely tolerated in 8 of 11 of the intubated patients following initiation of proning and APRV. CONCLUSIONS: Proning in combination with APRV provides improvement of hypoxemia with limitation of end-organ dysfunction and thereby facilitates recovery from severe 2009 pandemic influenza A (H1N1). 机器翻译 16、免费全文 Lung function and organ dysfunctions in 178 patients requiring mechanical ventilation during the 2009 influenza A (H1N1) pandemic. 免费全文链接直接下载 机器翻译 作者: Rios FG;Estenssoro E;Villarejo F;Valentini R;Aguilar L;Pezzola D;Valdez P;Blasco M;Orlandi C;Alvarez J; Saldarini F;Gomez A;Gomez PE;Deheza M;Zazu A;Quinteros M;Chena A;Osatnik J;Violi D;Gonzalez ME;Chiappero G ; 出处: Crit Care.2011V15N4 :R201 [IF:4.607] 联系地址: Sociedad Argentina de Terapia Intensiva, The Registry of the Argentinian Society of Intensive Care, Niceto Vega 4617, C1414BEA Ciudad de Buenos Aires, Argentina. [email protected]## ISSN: 1466-609X (Electronic)1364-8535 (Linking) 结论: These patients had severe, hypoxemic respiratory failure compatible with ARDS that persisted over time, frequently requiring rescue therapies to support oxygenation. NIV use is not warranted, given its high failure rate. Death and evolution to prolonged mechanical ventilation were common outcomes. 机器翻译 摘要: INTRODUCTION: Most cases of the 2009 influenza A (H1N1) infection are self-limited, but occasionally the disease evolves to a severe condition needing hospitalization. Here we describe the evolution of the respiratory compromise, ventilatory management and laboratory variables of patients with diffuse viral pneumonitis caused by pandemic 2009 influenza A (H1N1) admitted to the ICU. METHOD: This was a multicenter, prospective inception cohort study including adult patients with acute respiratory failure requiring mechanical ventilation (MV) admitted to 20 ICUs in Argentina between June and September of 2009 during the influenza A (H1N1) pandemic. In a standard case-report form, we collected epidemiological characteristics, results of real-time reverse-transcriptase-- polymerase-chain-reaction viral diagnostic tests, oxygenation variables, acid-base status, respiratory mechanics, ventilation management and laboratory tests. Variables were recorded on ICU admission and at days 3, 7 and 10. RESULTS: During the study period 178 patients with diffuse viral pneumonitis requiring MV were admitted. They were 44 +/-15 years of age, with Acute Physiology And Chronic Health Evaluation II (APACHE II) scores of 18 +/-7, and most frequent comorbidities were obesity (26%), previous respiratory disease (24%) and immunosuppression (16%). Non-invasive ventilation (NIV) was applied in 49 (28%) patients on admission, but 94% were later intubated.Acute respiratory distress syndrome (ARDS) was present throughout the entire ICU stay in the whole group (mean PaO2/FIO2 170 +/-25). Tidal-volumes used were 7.8 to 8.1 ml/kg (ideal body weight), plateau pressures always remained < 30 cmH2O, without differences between survivors and nonsurvivors; and mean positive end-expiratory pressure (PEEP) levels used were between 8 to 12 cm H2O. Rescue therapies, like recruitment maneuvers (8 to 35%), prone positioning (12 to 24%) and tracheal gas insufflation (3%) were frequently applied. At all time points, pH, platelet count, lactate dehydrogenase assay (LDH) and Sequential Organ Failure Assessment (SOFA) differed significantly between survivors and nonsurvivors. Lack of recovery of platelet count and persistence of leukocytosis were characteristic of non- survivors. Mortality was high (46%); and length of MV was 10 (6 to 17) days. CONCLUSIONS: These patients had severe, hypoxemic respiratory failure compatible with ARDS that persisted over time, frequently requiring rescue therapies to support oxygenation. NIV use is not warranted, given its high failure rate. Death and evolution to prolonged mechanical ventilation were common outcomes. Persistence of thrombocytopenia, acidosis and leukocytosis, and high LDH levels found in non- survivors during the course of the disease might be novel prognostic findings. 17、 Low- tidal volume mechanical ventilation in patients with acute respiratory distress syndrome caused by pandemic influenza A/H1N1 infection. 机器翻译 作者: Oh DK;Lee MG;Choi EY;Lim J;Lee HK;Kim SC;Lim CM;Koh Y;Hong SB ; 出处: J Crit Care.2013V28N4 :358-64 2.191] [IF: 联系地址: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul 138-736, Republic of Korea.## ISSN: 1557-8615 (Electronic)0883-9441 (Linking) 摘要: PURPOSE: Low- tidal volume (TV) mechanical ventilation is an important manipulation in managing patients with acute respiratory distress syndrome (ARDS). However, there is no definite evidence to support the use of this intervention in patients with viral etiologies. MATERIALS AND METHODS: A retrospective observational study of 104 patients with ARDS caused by pandemic influenza A/H1N1 infection admitted to 28 intensive care units (ICUs) in Korea was performed. Patients were categorized into 3 groups according to the TV they received: TV less than or equal to 7 mL/kg, TV greater than 7 mL/kg but less than or equal to 9 mL/kg, or TV greater than 9 mL/kg. RESULTS: The mean age was 55.1 years, and 55.8% were male (n = 58). Patients with TV greater than 9 mL/kg showed higher 28-day ICU mortality than the 2 other groups ( vs TV < 7 mL/kg, P = .007 and vs 7 mL/kg < TV atients with TV less than or equal to 7 mL/kg required ventilators, ICU admissions, and hospitalizations for fewer days than those with TV greater than 7 mL/kg (11.4 vs 6.1 days for 28-day ventilator-free days, 9.7 vs 4.9 days for 28-day ICU-free days, and 5.2 vs 2.4 days for 28- day hospital-free days, respectively). Tidal volume greater than 9 mL/kg ( hazard rate, 2.459; P = .003) and Sequential Organ Failure Assessment score ( hazard rate, 1.158; P = .014) were significant predictors of 28-day ICU mortality. CONCLUSIONS: Low-TV mechanical ventilation still benefits patients with ARDS caused by viral pneumonia. 18、 Mechanical ventilation in critically ill patients with 2009 influenza A(H1N1). 机器翻译 作者: Spronk PE;Schultz MJ ; 出处: JAMA.2010V303N10 :939-40; author reply 940-1 [IF:30.011] 19、 Maternal ventilation and sedation for H1N1 influenza resulting in fetal bladder rupture and urinary ascites. 机器翻译 作者: Chaudhari T;Robertson M;Ellwood D;Simpson E;Kecskes Z;Kent AL ; 出处: J Paediatr Child Health.2013V49N1 :E97-100 [IF:1.193] 联系地址: Department of Neonatology, Canberra Hospital, Woden, Australian Capital Territory, Australia.## ISSN: 1440-1754 (Electronic)1034-4810 (Linking) 摘要: Urinary ascites in a newborn infant is unusual and most commonly results from bladder perforation following umbilical arterial catheterisation or obstructive uropathy. The following report describes a case of fetal bladder rupture with urinary ascites in a mother ventilated and sedated with narcotics and benzodiazepines for H1N1 influenza. This was associated with a unique biochemical profile of hyponatraemia and elevated serum urea and creatinine characteristic of urinary autodialysis in the neonate.