IntroductionPatients with influenza A (H1N1)v infection have developed rapidly progressive lower respiratory tract disease resulting in respiratory failure. We describe the clinical and epidemiologic characteristics of the first 32 persons reported to be admitted to the intensive care unit (ICU) due to influenza A (H1N1)v infection in Spain.MethodsWe used medical chart reviews to collect data on ICU adult patients reported in a standardized form. Influenza A (H1N1)v infection was confirmed in specimens using real-time reverse transcriptase-polymerase-chain-reaction (RT PCR) assay.ResultsIllness onset of the 32 patients occurred between 23 June and 31 July, 2009. The median age was 36 years (IQR = 31 - 52). Ten (31.2%) were obese, 2 (6.3%) pregnant and 16 (50%) had pre-existing medical complications. Twenty-nine (90.6%) had primary viral pneumonitis, 2 (6.3%) exacerbation of structural respiratory disease and 1 (3.1%) secondary bacterial pneumonia. Twenty-four patients (75.0%) developed multiorgan dysfunction, 7 (21.9%) received renal replacement techniques and 24 (75.0%) required mechanical ventilation. Six patients died within 28 days, with two additional late deaths. Oseltamivir administration delay ranged from 2 to 8 days after illness onset, 31.2% received high-dose (300 mg/day), and treatment duration ranged from 5 to 10 days (mean 8.0 ± 3.3).ConclusionsOver a 5-week period, influenza A (H1N1)v infection led to ICU admission in 32 adult patients, with frequently observed severe hypoxemia and a relatively high case-fatality rate. Clinicians should be aware of pulmonary complications of influenza A (H1N1)v infection, particularly in pregnant and young obese but previously healthy persons.
Our findings suggest that early oseltamivir administration was associated with favourable outcomes among critically ill ventilated patients with 2009 H1N1 virus infection.
PCT has a high negative predictive value (94%) and lower PCT levels seems to be a good tool for excluding coinfection, particularly for patients without shock.
Positional changes have long been known to have a gravitational effect on the distribution of pulmonary blood flow. The effect of body position, supine, right and left lateral decubitus, on gas exchange were evaluated in 10 patients with predominantly unilateral lung disease. All patients were treated with mechanical ventilation and PEEP. Arterial blood gases, measured after 15 min in each of the three positions, showed that lying on the side of the "normal" lung resulted in a higher arterial pO2 (mean: 144 mmHg) than lying on that of the "damaged" lung (mean: 86 mmHg). The delta AapO2 values were 334 to 391 mmHg. Both differences were statistically significant (p less than 0.005). No significant changes mean arterial carbon dioxide tensions were noted.
Objective:
To analyze the impact of decannulation before intensive care unit discharge on ward survival in nonexperimental conditions.
Design:
Prospective, observational survey.
Setting:
Thirty-one intensive care units throughout Spain.
Patients:
All patients admitted from March 1, 2008 to May 31, 2008.
Interventions:
None.
Measurements and Main Results:
At intensive care unit discharge, we recorded demographic variables, severity score, and intensive care unit treatments, with special attention to tracheostomy. After intensive care unit discharge, we recorded intensive care unit readmission and hospital survival. Statistics: Multivariate analyses for ward mortality, with Cox proportional hazard ratio adjusted for propensity score for intensive care unit decannulation. We included 4,132 patients, 1,996 of whom needed mechanical ventilation. Of these, 260 (13%) were tracheostomized and 59 (23%) died in the intensive care unit. Of the 201 intensive care unit tracheostomized survivors, 60 were decannulated in the intensive care unit and 141 were discharged to the ward with cannulae in place. Variables associated with intensive care unit decannulation (non-neurologic disease [85% vs. 64%], vasoactive drugs [90% vs. 76%], parenteral nutrition [55% vs. 33%], acute renal failure [37% vs. 23%], and good prognosis at intensive care unit discharge [40% vs. 18%]) were included in a propensity score model for decannulation. Crude ward mortality was similar in decannulated and nondecannulated patients (22% vs. 23%); however, after adjustment for the propensity score and Sabadell Score, the presence of a tracheostomy cannula was not associated with any survival disadvantage with an odds ratio of 0.6 [0.3–1.2] (p = .1).
Conclusion:
In our multicenter setting, intensive care unit discharge before decannulation is not a risk factor.
This presentation is the result of the survey of eight industries with asbestosis risk in the Barcelona area (two of fibro-cement, three of auto brakes, two of textiles, and one of insulation materials). Of 1,472 workers, 271 or 18.5% have asbestosis. Pleural involvement in asbestosis is twice as common as that of the lung, 15.7% versus 8.5%. Pulmonary asbestosis without pleural participation is seen in only 2.6% of cases. Pleural plaques, calcified and not calcified, are detected in only a few cases. There is a definite correlation between the incidence of asbestosis and the exposure time: from 1% in the group of workers with less than five years of exposure up to 64.58% for those with 30 or more years of exposure. Clinical symptoms (cough, and/or expectoration, and/or dyspnea) were present in 68% of the studied population. Pulmonary crepitations are the most significant physical sign detected, observed in one quarter to one third of the patients. Pulmonary function tests in asbestos workers revealed restrictive and mixed type syndromes in 17% of the cases and obstructive syndrome in 36%. The percentages for those workers without asbestosis are 9% and 16%, respectively. It seems, therefore, that a bronchial factor plays a role in asbestosis. The bronchial pathology would be manifested clinically by the appearance or the exaggeration of the chronic bronchitis symptoms, and physiologically by the presence of the obstructive syndrome. There is no doubt that smoking enhances the incidence of asbestosis, aggravates the respiratory symptoms in those affected, and is a cause of further deterioration of pulmonary function.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.