Mechanical ventilation in patients with most severe forms of influenza a H1N1

Predrag Romic, Darko Nozic, Maja Surbatovic, Milic Veljovic, Mihajlo Stojic, Rade Vukovic
2011 Vojnosanitetski Pregled  
Vojnomedicinska akademija, *Klinika za anesteziologiju i intenzivnu terapiju, † Klinika za infektivne i tropske bolesti, Beograd, Srbija Apstrakt Uvod/Cilj. Pandemija gripa izazvanog virusom A H1N1 zapažena je po naglom širenju, ali i po posledicama kao što je teška akutna respiratorna slabost koja zahteva mehaničku ventilaciju (MV) i intenzivno lečenje (IL). Cilj rada je bio da se ustanovi značaj primene MV i prisustva komorbiditeta na ishod bolesti kod obolelih sa teškim oblikom influence
more » ... vane virusom A H1N1. Metode. U studiju bilo je uključeno pet bolesnika sa akutnom respiratornom insuficijencijom prouzrokovanom gripom A H1N1 koja je zahtevala MV. Tok i ishod lečenja posmatrani su u odnosu na uzrast i pol obolelih, prateća oboljenja, vreme pojave gripa, vreme prijema u odeljenje intenzivne terapije, vreme početka endotrahealne intubacije i MV, trajanje MV i pojavu sekundarnih infekcija. Rezultati. Tri ispitanika bila su na MV 39, 43, odnosno 20 dana i svi su preživeli. Umrla su dva ispitanika kod kojih je trajanje MV bilo značajno kraće (14 i 12 dana). Smrtni ishod objašnjen je fudroajantnim tokom bolesti i pratećim oboljenjima. Neočekivano, dužina MV pozitivno je korelisala sa preživljavanjem, iako se kod dva bolesnika koja su najduže bila na MV (43 i 39 dana), kao komplikacija razvila sekundarna bakterijska pneumonija. Zaključak. Intenzivno lečenje bolesnika sa respiratornom slabošću izazvanom virusom gripa A H1N1 zahteva MV koja se mora izvoditi shodno preporukama svetskih i evropskih foruma. Tome ide u prilog i neočekivano zapažanje da dužina trajanja MV negativno koreliše sa smrtnim ishodom. Intenzivno lečenje ovih bolesnika, posebno MV, zbog toga što može biti dugotrajno, zahteva specijalne anesteziološke timove, posebna, izolovana odeljenja za intenzivnu terapiju i visok stepen zaštite da bi se, kao u našoj studiji, potpuno izbeglo prenošenje infekcije na medicinsko osoblje. Ključne reči: virusne bolesti; grip A virus, podtip H1N1; disanje, mehaničko; lečenje, ishod. Abstract 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 influeza 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.
doi:10.2298/vsp1103235r pmid:21526552 fatcat:xqfsz6oqdfggfm5vn3y5ldbq4i