Pacientes com infecção por vírus A (H1N1) admitidos em unidades de terapia intensiva do Estado do Paraná, Brasil

Abstract

30). A média do escore Acute Physiologic Chronic Heatlh Evaluation II (APACHE II) foi de 15,0 ± 8,1. A mortalidade na unidade de terapia intensiva foi de 39,7%. Os principais fatores associados a essa mortalidade foram exame positivo no teste RT-PCR, níveis baixos de relação PaO2/FiO2 inicial, níveis elevados de uréia e desidrogenase lática iniciais, nível de pressão expiratória final positiva necessária, necessidade de posição prona e de drogas vasopressoras. CONCLUSÕES: Pacientes admitidos em unidades de terapia intensiva com infecção por vírus A(H1N1) apresentaram alto risco de óbito, particularmente devidos ao comprometimento respiratório. O exame RT-PCR positivo, níveis de uréia e de desidrogenase láctica, além baixa PaO2/FiO2 e necessidades de PEEP alta, foram relacionados com uma maior mortalidade.]]>

Apresentação clínica e evolução de pacientes com infecção por Influenza A (H1N1) que necessitaram de terapia intensiva durante a pandemia de 2009

“…However, patients requiring mechanical ventilation remained on it for a prolonged time (median 8.5 days) and required high pressures, data similar to the literature reports. (5)(6)(7)(8)(9)(10)(11)(12)19) Interestingly, non-invasive ventilation failure occurred in one half of our patients. The failure rate was also high in other cohorts, 72% in a Mexican study, (8) 75% in Spain, (9) and 85% in Canada (7) and the United States.…”

“…In our study, the ratio of patients requiring mechanical ventilation was low as compared with the literature. (5)(6)(7)(8)(9)(10)(11) This was probably due to less severely ill patients admitted to ICU in our cohort, as measured with the SAPS 3 and SOFA scores, which were the varia bles associated with invasive mechanical ventilation need. However, patients requiring mechanical ventilation remained on it for a prolonged time (median 8.5 days) and required high pressures, data similar to the literature reports.…”

“…Large number of quickly disseminating cases was recorded, involving mainly young patients, as suggested by many published cohorts. (3,10,11,(13)(14)(15)(16)(17)(18)(19) Given the large number of cases, although the disease's mortality was apparently low, (3,10,(15)(16)(17)(18) many patients were admitted to ICUs, leading to several studies reporting these cases clinical features and outcomes. (5)(6)(7)(8)(9)(10)12,(19)(20)(21) In this study we revised data from 22 patients admitted to two private hospitals' intensive care units in São Paulo, Brazil.…”

“…(23) Overall, obese patients rate admitted to the ICU with complicated influenza A (H1N1)/2009 infections was higher than for the overall population in several studies. (9)(10)(11)(12)15,19) The reason for increased morbidity in obese patients is not clear, but is likely to involve respiratory mechanics changes, coexistence with cardiovascular and metabolic diseases, or issues related to these patients treatment. (24) In our cohort, the prevalence of pregnancy was 9.1%, and all of our pregnant patients were in their third trimester.…”

“…Mortality rate was variable on the several articles reporting patients requiring intensive care unit (ICU) admission. (5)(6)(7)(8)(9)(10)(11)(12) So far, only one cases series of patients admitted to ICU was published in Brazil, (11) with some similarities with the Mexican experience, (8) nevertheless the outcomes were different from other countries.…”