Critically ill patients with H1N1 influenza A undergoing extracorporeal membrane oxygenation

The most common cause of death due to the H1N1 subtype of influenza A virus (swine flu) in the 2009 to 2010 epidemic was severe acute respiratory failure that persisted despite advanced mechanical ventilation strategies. Extracorporeal membrane oxygenation (ECMO) was used as a salvage therapy for patients refractory to traditional treatment. At Legacy Emanuel Hospital, Portland, Oregon, the epidemic resulted in a critical care staffing crisis. Among the 15 patients with H1N1 influenza A treated with ECMO, 4 patients received the therapy simultaneously. The role of ECMO in supporting patients with severe respiratory failure due to H1N1 influenza is described, followed by discussions of the nursing care challenges for each body system. Variations from standards of care, operational considerations regarding staff workload, institutional burden, and emotional wear and tear of the therapy on patients, patients' family members, and the entire health care team are also addressed. Areas for improvement for providing care of the critically ill patient requiring ECMO are highlighted in the conclusion.     

Avian influenza (H5N1): implications for intensive care

Background As influenza A/H5N1 spreads around the globe the risk of an epidemic increases.Discussion Review of the cases of influenza A/H5N1 reported to date demonstrates that it causes a severe illness, with a high proportion of patients (63%) requiring advanced organ support. Of these approx. 68% develop multiorgan failure, at least 54% develop acute respiratory distress syndrome, and 90% die. Disease progression is rapid, with a median time from presentation to hospital to requirement for advanced organ support of only 2 days.Conclusion The infectious nature, severity and clinical manifestations of the disease and its potential for pandemic spread have considerable implications for intensive care in terms of infection control, patient management, staff morale and intensive care expansion.     

甲型H1N1流感危重患儿临床观察及护理

目的 探讨危重症甲型H1N1流感患儿的病情观察重点及护理要点.方法 观察护理27例甲型H1N1流感危重患儿,其中重症肺炎24例,合并急性呼吸窘迫综合征(ARDS)11例、多器官功能衰竭(MODS)9例、甲流相关性脑病7例.结果 危重患儿以学龄儿童为多,重症肺炎以气促、低氧血症为突出症状,树样管型支气管肺炎表现为严重喘憋,合并甲流相关性脑病表现为不同程度神经精神症状,出现深昏迷者病情不可逆转.所有患儿中治愈出院24例,3例合并甲流相关急性坏死性脑病患儿死亡.结论 早期识别甲流H1N1危重症的先兆症状,尽早给予呼吸支持、早期干预与治疗甲流相关性脑病,是控制病情进展降低病死率的关键.     

1例甲型H1N1流感患儿的护理

甲型H1N1流感是甲型（A型）流感病毒引起的一种急性呼吸道传染性疾病。2009年3月始,墨西哥和美国等部分地区爆发的甲型H1N1流感疫情波及全球20多个国家和地区,其临床早期症状类似于普通流感,有发热、咳嗽、疲劳、食欲不振等症状,还可出现腹泻或呕吐等症状。病情进展迅速,可突然高热,重者可因呼吸衰竭、多器官损伤导致死亡。     

3例甲型H1N1流感危重症患儿的护理

报告3例危重症甲型H1Nl流感患儿的护理方法。重点介绍了患儿病情变化时的急救处理、呼吸机支持期间的气道管理、病情观察、维持稳定的生命体征、用药管理、心理护理,以及严格的消毒隔离。经精心护理,3例患儿转危为安,均治愈出院。     

杭州地区2009甲型H1N1流感重症患儿中人类偏肺病毒感染状况研究

目的了解杭州地区2009甲型H1N1流感（以下简称甲流）重症患儿中人类偏肺病毒（hMPV）的感染状况。方法采集2009年11月至2010年1月确诊为甲流重症患儿的呼吸道样本79份,用传统逆转录聚合酶链反应（RT-PCR）、荧光定量RT-PCR方法检测hMPV及其他呼吸道病毒。选择hMPV阳性样本PCR扩增产物进行核苷酸测序,将所测序列与GenBank比对分析,并绘制基因进化树。结果79份甲流病毒阳性样本中,hMPV及其它呼吸道病毒阳性率20．25％（16,79）,hMPV阳性PCR扩增产物4份,占甲流重症病例的5．06％（4,79）。其中3份hMPV阳性PCR扩增产物核苷酸序列相似性为99．1％～99．5％,与广东省流行株GD．165,泰国株155N及B1代表株高度相似,并且被GenBank收录。结论杭州地区确诊感染的2009甲型H1N1流感重症病例中存在与hMPV共同感染状况,且hMPV均为B1基因型。     

1例重症甲型H1N1流感孕妇的救治及护理

总结1例重症甲型H1N1流感孕妇的救治过程及护理措施。使用体外膜肺氧合对患者进行抢救,同时密切关注患者及胎儿情况,做好循环系统监测、防护隔离、预防出血、改善通气、早期康复锻炼、营养护理、孕妇及胎儿的辐射防护和心理护理等方面的工作。最终患者病情好转并转回当地医院继续治疗。     

63例甲型H1N1流感重症患者的护理体会

目的 探讨甲型H1N1流感重症患者的护理方法.方法 回顾63例甲型H1N1流感重症患者临床资料,根据所有重症病例的临床特点,针对患者的个性化特点提供心理护理,严密监测病情,落实氧疗,加强气道管理,注重液体管理,做好肺复张的护理,实施标准预防.结果 所有病例均获得痊愈出院,未发生护理并发症及院内感染.结论 合理的临床治疗...     

48例儿童甲型H1N1流感病例临床分析

目的探讨儿童甲型H1N1流感患者的临床特征和治疗特点。方法回顾分析广东省人民医院2009年9月19日～12月30日收治的48例住院儿童甲型H1N1流感病例的临床资料,总结其临床特征及治疗经验。结果 14例为轻症患儿,30例为重症患儿,4例为危重症患儿。48例确诊病例均为本地发病者,其中10例有明确的甲型H1N1流感患者接触史。表现为发热（100%）,咳嗽（93.8%）,气促（35.4%）,喘息（25%）,呼吸困难（4.16%）,腹泻（12.5%）;50%患儿合并肺炎,2例并发心肌炎,5例患儿合并胸腔积液,其中2例出现呼吸衰竭;75%患儿白细胞正常或减低,45.8%患儿有肌酸激酶（CK）增高。按照卫生部《甲型H1N1流感诊疗方案（2009年第三版）》给予奥司他韦抗病毒、预防感染、吸氧、营养心肌及对症支持治疗,积极治疗基础疾病,必要时给予呼吸机支持、胸腔穿刺引流,所有患儿均痊愈。结论甲型H1N1流感患儿临床表现以呼吸系统症状为主,肺炎是常见并发症,少数患儿合并胸腔积液,甚至出现呼吸衰竭;接近半数患儿伴有不同程度心肌酶损害,少数并发心肌炎;尚未发现神经系统并发症;奥司他韦治疗敏感,采取综合治疗预后良好。     

甲型H1N1流感重症和危重症患儿22例临床分析

目的分析甲型H1N1流感儿童重症和危重病例的临床特点,并对其诊治方法进行探讨。方法对2009年11月1日至2010年2月1日湖南省人民医院附属儿科医学中心收治的22例甲型H1N1流感重症和危重患儿的临床症状、实验室检查及影像学资料进行回顾性分析。结果所有患儿均有发热及咳嗽症状,伴气喘7例,气促呼吸困难7例,腹泻5例,恶心呕吐7例,抽搐,肢体抖动,双眼凝视2例,精神差6例,皮肤黏膜出血1例。实验室检查白细胞正常或下降为主,有神经系统并发症的患儿腰穿脑脊液常规生化检查无异常发现。入院肺部CT影像学表现主要为渗出性改变。经奥司他韦抗病毒,使用丙种球蛋白,激素抗炎,呼吸机支持通气等治疗,2例患儿死亡,其余患儿预后良好。结论新型甲型H1N1流感在儿童以肺部损伤为主,大多数预后较好,少数患儿因有原发基础疾病或病情进展迅速,伴发多器官功能衰竭。因此,对危重患儿应采取以抗病毒为主的综合支持治疗以降低病死率。     

甲型H1N1(危重症)流感患者的护理体会及隔离防护

目的 了解重症甲型H1N1流感患者的临床特点、护理措施、预后和隔离防护措施.方法 对我科2009年11月至2010年2月收治的7例重症甲型H1N1患者的临床资料进行回顾性分析.结果 患者年龄2～71岁,男6例,女1例,平均体重指数27.8(2岁儿童除外),均为本地病例,均无与确诊患者密切接触史,以咳嗽、发热、咽痛为首发症状,继而出现胸闷、呼吸困难、血氧饱和度下降转入ICU.外周血白细胞大多正常或降低,淋巴细胞明显下降,胸片X线均出现浸润阴影.治疗以综合治疗为主,5例给予无创辅助通气结合90°侧卧位翻身,2例给予气管插管接呼吸机辅助通气结合俯卧位通气.均予特级护理,严密监测生命体征变化,着重做好呼吸机使用的护理、俯卧位通气的护理和心理护理.5例痊愈出院,2例死亡.严格执行隔离防护措施,未发生院内感染.结论 体位变化、呼吸机使用的护理和心理护理是重症甲型H1N1患者护理过程中的重要方面.只有医务人员严格执行各项防控措施,才可以杜绝院内感染的发生.     

Acute kidney injury in critical ill patients affected by influenza A (H1N1) virus infection

Introduction

Little information exists about the impact of acute kidney injury (AKI) in critically ill patients with the pandemic 2009 influenza A (H1N1) virus infection.

Methods

We conducted a prospective, observational, multicenter study in 148 Spanish intensive care units (ICUs). Patients with chronic renal failure were excluded. AKI was defined according to Acute Kidney Injury Network (AKIN) criteria.

Results

A total of 661 patients were analyzed. One hundred eighteen (17.7%) patients developed AKI; of these, 37 (31.4%) of the patients with AKI were classified as AKI I, 15 (12.7%) were classified as AKI II and 66 (55.9%) were classified as AKI III, among the latter of whom 50 (75.7%) required continuous renal replacement therapy. Patients with AKI had a higher Acute Physiology and Chronic Health Evaluation II score (19.2 ± 8.3 versus 12.6 ± 5.9; P < 0.001), a higher Sequential Organ Failure Assessment score (8.7 ± 4.2 versus 4.8 ± 2.9; P < 0.001), more need for mechanical ventilation (MV) (87.3% versus 56.2%; P < 0.01, odds ratio (OR) 5.3, 95% confidence interval (CI) 3.0 to 9.4), a greater incidence of shock (75.4% versus 38.3%; P < 0.01, OR 4.9, 95% CI, 3.1 to 7.7), a greater incidence of multiorgan dysfunction syndrome (92.4% versus 54.7%; P < 0.01, OR 10.0, 95% CI, 4.9 to 20.21) and a greater incidence of coinfection (23.7% versus 14.4%; P < 0.01, OR 1.8, 95% CI, 1.1 to 3.0). In survivors, patients with AKI remained on MV longer and ICU and hospital length of stay were longer than in patients without AKI. The overall mortality was 18.8% and was significantly higher for AKI patients (44.1% versus 13.3%; P < 0.01, OR 5.1, 95% CI, 3.3 to 7.9). Logistic regression analysis was performed with AKIN criteria, and it demonstrated that among patients with AKI, only AKI III was independently associated with higher ICU mortality (P < 0.001, OR 4.81, 95% CI 2.17 to 10.62).

Conclusions

In our cohort of patients with H1N1 virus infection, only those cases in the AKI III category were independently associated with mortality.     

32例危重症甲型H1N1流感患者的临床观察及护理

目的总结危重症甲型H1N1患者的治疗方法及护理措施。方法对32例H1N1患者均机械通气治疗,选择压力通气模式,即同步间歇指令通气压力模式（SIMV＋PSV＋PEEP）,PEEP及FiO2的设定根据患者的氧合水平进行滴定式设定。控制潮气量（6—8ml／kg）,PEEP不超过20cmH2O,限制平台压不超过35cmH2O,每小时记录心率、血压、脉搏、血氧饱和度,左、右侧俯卧位通气每2h交替一次,每次吸痰后及时给予肺复张（LR）,每天进行动脉血气分析、血常规、c-反应蛋白,凝血指标,肝功、肾功、心肌酶监测、胸部x线检查。结果32例中26例动脉血气指标得到改善,PaO2〉80mmHg,病情好转,并逐步脱机,6例死于顽固性低氧血症。结论甲型H1N1患者在治疗过程中尽早给予奥斯他韦治疗,实施肺保护通气策略,密切观察生命体征,及时监测化验项目,加用俯卧位通气,加强气道管理、减少吸痰次数是护理的关键。