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DOI: 10.1016/j.medine.2019.11.007
Available online 24 April 2020
Risk factors associated to noninvasive ventilation failure in primary influenza A pneumonia in the critical care setting
Factores de riesgo de fracaso de ventilación no invasiva en neumonía primaria por influenza A en pacientes críticos
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H. Hernández Garcés
Corresponding author
hektorhernandez84@gmail.com

Corresponding author.
, A. Navarro Lacalle, L. Lizama López, R. Zaragoza Crespo
Servicio de Medicina Intensiva, Hospital Universitario Doctor Peset, Valencia, Spain
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Tables (3)
Table 1. Baseline characteristics of the patients subjected to mechanical ventilation. Comparison of patients with NIV failure versus success.
Table 2. Stay and mortality among the patients with NIV failure, NIV success and IMV. Comparison of the patients with NIV failure versus those receiving IMV as first support measure.
Table 3. Univariate and multivariate analysis of comorbidities and parameters associated to NIV failure.
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Abstract
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 72h 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=0.04), with a higher SOFA score (7 vs. 4; p=0.01) and greater early hemodynamic failure (61.1 vs. 8%; p=0.01). In addition, they presented longer ICU (26.28 vs. 6.88 days; p=0.01) and hospital stay (32.78 vs. 18.8 days; p=0.01). The ICU mortality rate was also higher in the NIV failure group (38.9 vs. 0%; p=0.02). 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.

Keywords:
Influenza A
Noninvasive ventilation
Pneumonia
Risk factors
Failure
Mortality
Resumen
Objetivo

Analizar factores de riesgo de fracaso de la ventilación no invasiva (VNI) en pacientes que ingresan en una unidad de cuidados intensivos (UCI) por neumonía primaria por virus influenza A (H1N1)pdm09. Demostrar que los pacientes que fracasan con la VNI tienen mayor mortalidad y estancias más largas.

Diseño

Estudio de cohorte.

Ámbito

UCI polivalente de un hospital universitario de 16 camas.

Pacientes

Pacientes adultos que ingresaron en la UCI en los que se confirmó el diagnóstico de neumonía por influenza A (H1N1)pdm09 y que recibieron ventilación mecánica.

Variables

Edad, sexo, puntuaciones de gravedad, administración de corticoides, oseltamivir dentro de las 72h de la sintomatología, días de sintomatología previos al ingreso, cuadrantes afectados, fracaso hemodinámico, renal y datos analíticos al ingreso, mortalidad y estancia en UCI y hospitalaria.

Resultados

Ingresaron 54 pacientes y 49 fueron ventilados. Sexo femenino, 29 (59,2%) y una edad media±desviación estándar de 66,77±14,77 años. Fueron ventilados con VNI 43 (87,75%), de los que fracasaron 18 (41,9%). Los pacientes que fracasaron presentaron menor edad (63 vs. 74 años; p=0,04), mayor puntuación SOFA (7 vs. 4; p=0,01) y mayor fracaso hemodinámico (61,1 vs. 8%; p=0,01). Además, presentaron estancias más largas tanto en UCI (26,28 vs. 6,88 días; p=0,01) como hospitalarias (32,78 vs. 18,8 días; p=0,01), y mayor mortalidad en UCI (38,9 vs. 0%; p=0,02). Se identificaron como factores de riesgo de fracaso a VNI recibir corticoides (OR 7,08; IC 95% 1,23-40,50) y el fallo hemodinámico precoz (OR 14,77; IC 95% 2,34-92,97).

Conclusiones

El tratamiento con corticoides y el fracaso hemodinámico precoz se asociaron con el fracaso de la VNI en pacientes con neumonía primaria por virus influenza A (H1N1)pdm09. Estos tienen una mortalidad superior.

Palabras clave:
Influenza A
Ventilación no invasiva
Neumonía
Factores de riesgo
Fracaso
Mortalidad

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