Critically Ill Patients With 2009 Influenza A(H1N1) Infection in Canada

被引：1030

作者：

Kumar, Anand ^{[1
,2
]}

Zarychanski, Ryan ^{[3
]}

Pinto, Ruxandra ^{[4
]}

Cook, Deborah J. ^{[5
]}

Marshall, John ^{[8
]}

Lacroix, Jacques ^{[9
]}

Stelfox, Tom ^{[10
,11
]}

Bagshaw, Sean ^{[12
]}

Choong, Karen ^{[7
]}

Lamontagne, Francois ^{[13
]}

Turgeon, Alexis F. ^{[14
]}

Lapinsky, Stephen ^{[15
]}

Ahern, Stephane P. ^{[17
]}

Smith, Orla ^{[8
]}

Siddiqui, Faisal ^{[1
,2
]}

Jouvet, Philippe ^{[9
]}

Khwaja, Kosar ^{[18
]}

McIntyre, Lauralyn ^{[19
]}

Menon, Kusum ^{[20
]}

Hutchison, Jamie ^{[21
]}

Hornstein, David ^{[22
]}

Joffe, Ari ^{[12
]}

Lauzier, Francois ^{[14
]}

Singh, Jeffrey ^{[16
]}

Karachi, Tim ^{[6
]}

Wiebe, Kim ^{[1
,2
]}

Olafson, Kendiss ^{[1
,2
]}

Ramsey, Clare ^{[1
,2
]}

Sharma, Sat ^{[1
,2
]}

Dodek, Peter ^{[23
]}

Meade, Maureen ^{[5
]}

Hall, Richard ^{[24
]}

Fowler, Robert A. ^{[4
]}

机构：

[1] Hlth Sci Ctr, Sect Crit Care Med, Winnipeg, MB R3E 0Z3, Canada

[2] St Boniface Gen Hosp, Winnipeg, MB R2H 2A6, Canada

[3] Cancercare Manitoba, Dept Med Oncol & Hematol, Winnipeg, MB, Canada

[4] Sunnybrook Hlth Sci Ctr, Toronto, ON M4N 3M5, Canada

[5] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada

[6] McMaster Univ, Dept Med, Hamilton, ON, Canada

[7] McMaster Univ, McMaster Childrens Hosp, Hamilton, ON, Canada

[8] St Michaels Hosp, Dept Crit Care Med, Toronto, ON M5B 1W8, Canada

[9] Univ Montreal, Dept Pediat, CHU St Justine, Montreal, PQ H3C 3J7, Canada

[10] Univ Calgary, Dept Crit Care Med, Calgary, AB, Canada

[11] Univ Calgary, Dept Community Hlth Sci, Calgary, AB, Canada

[12] Univ Alberta, Div Crit Care Med, Edmonton, AB, Canada

[13] Univ Sherbrooke, Dept Med, Med Ctr, Sherbrooke, PQ J1K 2R1, Canada

[14] Univ Laval, Hop Enfants Jesus, Ctr Rech CHA, Quebec City, PQ, Canada

[15] Univ Toronto, Mt Sinai Hosp, Intens Care Unit, Toronto, ON M5G 1X5, Canada

[16] Univ Toronto, Univ Hlth Network, Toronto, ON M5G 1X5, Canada

[17] Univ Montreal, Dept Med, Hop Maison Neuve Rosemont, Montreal, PQ H3C 3J7, Canada

[18] McGill Univ, Ctr Hlth, Trauma Serv, Montreal, PQ, Canada

[19] Ottawa Hlth Res Inst, Clin Epidemiol Unit, Ottawa, ON, Canada

[20] Childrens Hosp Eastern Ontario, Clin Res Unit, Ottawa, ON K1H 8L1, Canada

[21] Hosp Sick Children, Dept Crit Care Med, Toronto, ON M5G 1X8, Canada

[22] SMBD Jewish Gen Hosp, Montreal, PQ, Canada

[23] Univ British Columbia, Vancouver, BC V5Z 1M9, Canada

[24] Queen Elizabeth 2 Hlth Sci Ctr, Dept Anesthesia, Halifax, NS, Canada

来源：

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2009年 / 302卷 / 17期

基金：

加拿大健康研究院;

关键词：

MORTALITY; EPIDEMIOLOGY;

D O I：

10.1001/jama.2009.1496

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Context Between March and July 2009, the largest number of confirmed cases of 2009 influenza A(H1N1) infection occurred in North America. Objective To describe characteristics, treatment, and outcomes of critically ill patients in Canada with 2009 influenza A(H1N1) infection. Design, Setting, and Patients A prospective observational study of 168 critically ill patients with 2009 influenza A(H1N1) infection in 38 adult and pediatric intensive care units (ICUs) in Canada between April 16 and August 12, 2009. Main Outcome Measures The primary outcome measures were 28-day and 90-day mortality. Secondary outcomes included frequency and duration of mechanical ventilation and duration of ICU stay. Results Critical illness occurred in 215 patients with confirmed (n=162), probable (n=6), or suspected (n=47) community-acquired 2009 influenza A(H1N1) infection. Among the 168 patients with confirmed or probable 2009 influenza A(H1N1), the mean(SD) age was 32.3 (21.4) years; 113 were female (67.3%) and 50 were children (29.8%). Overall mortality among critically ill patients at 28 days was 14.3% (95% confidence interval, 9.5%-20.7%). There were 43 patients who were aboriginal Canadians (25.6%). The median time from symptom onset to hospital admission was 4 days (interquartile range [IQR], 2-7 days) and from hospitalization to ICU admission was 1 day (IQR, 0-2 days). Shock and nonpulmonary acute organ dysfunction was common (Sequential Organ Failure Assessment mean [SD] score of 6.8 [3.6] on day 1). Neuraminidase inhibitors were administered to 152 patients (90.5%). All patients were severely hypoxemic (mean [SD] ratio of PaO2 to fraction of inspired oxygen [FIO2] of 147 [128] mm Hg) at ICU admission. Mechanical ventilation was received by 136 patients (81.0%). The median duration of ventilation was 12 days (IQR, 6-20 days) and ICU stay was 12 days (IQR, 5-20 days). Lung rescue therapies included neuromuscular blockade (28% of patients), inhaled nitric oxide (13.7%), high-frequency oscillatory ventilation (11.9%), extracorporeal membrane oxygenation (4.2%), and prone positioning ventilation (3.0%). Overall mortality among critically ill patients at 90 days was 17.3%(95% confidence interval, 12.0%-24.0%; n=29). Conclusion Critical illness due to 2009 influenza A(H1N1) in Canada occurred rapidly after hospital admission, often in young adults, and was associated with severe hypoxemia, multisystem organ failure, a requirement for prolonged mechanical ventilation, and the frequent use of rescue therapies. JAMA. 2009;302(17):1872-1879

引用

页码：1872 / 1879

页数：8

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