An assessment of H1N1 influenza-associated acute respiratory distress syndrome severity after adjustment for treatment characteristics
| Autor: | Tyler B. Anderson, Naeem A. Ali, Madhuri M. Sopirala, Matthew C. Exline, Gary Phillips, Brent P. Riscili, Hallie C. Prescott |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2011 |
| Předmět: |
Male
Viral Diseases ARDS Critical Care and Emergency Medicine medicine.medical_treatment lcsh:Medicine Severity of Illness Index Prone ventilation Cohort Studies Influenza A Virus H1N1 Subtype 0302 clinical medicine 030212 general & internal medicine lcsh:Science Tidal volume 2. Zero hunger Respiratory Distress Syndrome Multidisciplinary Ventilatory Support Middle Aged Respiratory Function Tests 3. Good health Infectious Diseases Treatment Outcome Medicine Female SOFA score Research Article Adult medicine.medical_specialty Fluid Management Multiple Organ Failure Resuscitation Lung injury 03 medical and health sciences Respiratory Failure Severity of illness Extracorporeal membrane oxygenation medicine Humans Intensive care medicine Mechanical ventilation business.industry lcsh:R medicine.disease Influenza respiratory tract diseases 030228 respiratory system Emergency medicine lcsh:Q business |
| Zdroj: | PLoS ONE, Vol 6, Iss 3, p e18166 (2011) PLoS ONE |
| ISSN: | 1932-6203 |
| Popis: | Pandemic influenza caused significant increases in healthcare utilization across several continents including the use of high-intensity rescue therapies like extracorporeal membrane oxygenation (ECMO) or high-frequency oscillatory ventilation (HFOV). The severity of illness observed with pandemic influenza in 2009 strained healthcare resources. Because lung injury in ARDS can be influenced by daily management and multiple organ failure, we performed a retrospective cohort study to understand the severity of H1N1 associated ARDS after adjustment for treatment. Sixty subjects were identified in our hospital with ARDS from "direct injury" within 24 hours of ICU admission over a three month period. Twenty-three subjects (38.3%) were positive for H1N1 within 72 hours of hospitalization. These cases of H1N1-associated ARDS were compared to non-H1N1 associated ARDS patients. Subjects with H1N1-associated ARDS were younger and more likely to have a higher body mass index (BMI), present more rapidly and have worse oxygenation. Severity of illness (SOFA score) was directly related to worse oxygenation. Management was similar between the two groups on the day of admission and subsequent five days with respect to tidal volumes used, fluid balance and transfusion practices. There was, however, more frequent use of "rescue" therapy like prone ventilation, HFOV or ECMO in H1N1 patients. First morning set tidal volumes and BMI were significantly associated with increased severity of lung injury (Lung injury score, LIS) at presentation and over time while prior prescription of statins was protective. After assessment of the effect of these co-interventions LIS was significantly higher in H1N1 patients. Patients with pandemic influenza-associated ARDS had higher LIS both at presentation and over the course of the first six days of treatment when compared to non-H1N1 associated ARDS controls. The difference in LIS persisted over the duration of observation in patients with H1N1 possibly explaining the increased duration of mechanical ventilation. |
| Databáze: | OpenAIRE |
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