Risk factors associated to noninvasive ventilation failure in primary influenza A pneumonia in the critical care setting
Por:
Hernández Garcés H, Navarro Lacalle A, Lizama López L and Zaragoza Crespo R
Publicada:
1 ago 2021
Ahead of Print:
7 ene 2020
Categoría:
Critical care and intensive care medicine
Resumen:
Objective: To evaluate the risk factors associated to noninvasive mechanical ventilation (NIV) failure in patients with primary pneumonia due to influenza A (H1N1)pdm09 virus admitted to the intensive care unit (ICU), and to demonstrate the association of NIV failure to increased mortality and longer stays.
Design: A cohort study was carried out.
Scope: A mixed ICU (16 beds) in a teaching hospital.
Patients: Adult patients admitted to the ICU with a diagnosis of pneumonia due to influenza A (H1N1)pdm09 virus requiring mechanical ventilation.
Measurements: Age, sex, severity scores, administration of corticosteroids, oseltamivir within 72 h of symptoms onset, days of symptoms prior to admission, affected quadrants, hemodynamic parameters, renal failure, laboratory test data on admission, mortality and stay in ICU and in hospital.
Results: A total of 54 patients were admitted to the ICU and 49 were ventilated; 29 were females (59.2%), and the mean age + standard deviation was 66.77 + 14.77 years. Forty-three patients (87.75%) were ventilated with NIV, and 18 (41.9%) of them failed. Patients with NIV failure were younger (63 vs. 74 years; P = .04), with a higher SOFA score (7 vs. 4; P = .01) and greater early hemodynamic failure (61.1 vs. 8%; P= .01). In addition, they presented longer ICU (26.28 vs. 6.88 days; P= .01) and hospital stay (32.78 vs. 18.8 days; P= .01). The ICU mortality rate was also higher in the NIV failure group (38.9 vs. 0%; P = .02). In the multivariate analysis, corticosteroid therapy (OR 7.08; 95% CI 1.23-40.50) and early hemodynamic failure (OR 14.77; 95% CI 2.34-92.97) were identified as independent risk factors for NIV failure.
Conclusions: Treatment with corticosteroids and early hemodynamic failure were associated to NIV failure in patients with primary pneumonia due to influenza A (H1N1)pdm09 virus infection admitted to the ICU. The failure of NIV was associated to increased mortality. (C) 2019 Elsevier Espan tilde a, S.L.U. y SEMICYUC. All rights reserved.
Filiaciones:
:
Servicio de Medicina Intensiva, Hospital Universitario Doctor Peset, Valencia, España
:
Servicio de Medicina Intensiva, Hospital Universitario Doctor Peset, Valencia, España
:
Servicio de Medicina Intensiva, Hospital Universitario Doctor Peset, Valencia, España
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Servicio de Medicina Intensiva, Hospital Universitario Doctor Peset, Valencia, España
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