Clinical analysis of critically ill patients with pneumonia of influenza A H1N1

Abstract

Objective To analyze the clinical features of critically ill patients with pneumonia of influenza A H1N1 and the risk factors associated with critically ill patients.Methods The clinical features of 51 patients with pneumonia of influenza A H1N1 hospitalized at Chengde Third Hospital from September to December of 2009 were retrospectively analyzed and the comparative analysis was performed on the clinical features of the severe and the critically ill patients.Results Critically ill patisents all had dyspnea,average oxygenation index was (188.4±68.5) mm Hg and average APACHE Ⅱ score was 12.5±4.5,and ten patients (41.7％) had bloody spumtum,six critically ill patients (25.0％) progressed to acute repiratory distress syndrome (ARDS).The ratios of patients with increased leukocytosis,decreased lymphocytes,elevated blood sugar,positive sputum culture,and received oseltamivir (300 mg/d),meropenem,gamma globulin,convalescen plasma,mechanical ventilation,glucocorticoid were higher in critical group than those in severe group (all P ＜0.05).The number of damaged lung field,viral clearance time,and hospitalization time were higher in critical group than those in severe group (all P ＜0.05).Logistic regression analysis showed that pneumonia of inflenza A H1N1 with expectoration as initial symptom,the onset to first dose of oseltamivir ＞48 hours,and presences of underlying disease was associated with higher fatal risks (OR was 3.181,19.596,7.437 respectively,all P ＜0.05).Conclusions Pneumonia of inflenza A H1N1 with expectoration as initial sympom,the onset to first dose of oseltamivir ＞48 hours,and presences of underlying disease is susceptible to critical illness.Damaged lung tissue of critically ill patients is wide and some are complicated with bacterial infection,viral clearance time and hospital stay are longer,part of patients progress to ARDS, Key words: Influenza A (H1N1); Pneumonia; Critical illness; Clinical features; Risk factor