Sena ATAMAN, Cenk KIRAKLI, Özlem EDİBOĞLU

Hipoksemik solunum yetmezliği ile yoğun bakıma başvuran influenza pnömonili hastaların özellikleri

Giriş: Epidemi mevsiminde influenza pnömonisi sebebiyle gelişen hipoksemik solunum yetmezliğinde yoğun bakım ve mekanik ventilasyon tedavisi gerekebilir. Bu hastalar genç olmasına rağmen mortalitesi yüksektir. Materyal ve Metod: Aralık 2015 ile Mart 2016 tarihleri arasında, klinik ve radyolojik olarak viral pnömoni şüphesi olan hastalar çalışmaya alındı. Demografik özellikler, risk faktörleri, mekanik ventilasyon desteği ihtiyacı ve tipi, laboratuvar değerleri, pulmoner (ECMO) ve renal (CRRT) destek ihtiyacı ve mortalite oranı kaydedildi. Bulgular: Yirmi iki hasta çalışmaya dahil edildi. Ortalama APACHE II skoru 19 (13-25) ve yaş 45 (36-63) idi. Semptomların başlama süresi 7 (6-9) gün idi. En sık görülen semptomlar öksürük, ateş, nefes darlığıydı. Sekiz (%36) hastada risk faktörü mevcuttu. Mekanik ventilasyon sırasında uygulanan maksimum PEEP değeri yaşayan hastalarda daha düşük idi [10 (8-10) vs. 13 (10-16), p= 0.025)]. PaO2/FiO2 oranı 100’ün altında geçirilen süre ölen hastalarda daha kısa idi [72 (24-90) vs. 0 (0-48) saat, p= 0.024]. Ölen hastalarda serum albumin düzeyi daha düşük bulundu [2.6 (2-3.1) vs. 3.5 (2.6-3.7) g/dL, p= 0.033]. İki hastaya ECMO ve 5 hastaya CRRT uygulandı. Survi oranı NIV başarısı olan hastalarda % 88 (7/8) iken, invaziv mekanik ventilasyon uygulandığında %7 (1/14) olarak bulundu (p< 0.001). Mortalite %64 olarak bulundu. Sonuç: İnfluenza pnömonisi sırasında ARDS ve hipoksemik solunum yetmezliği görülebilmektedir. Tam destek uygulansa dahi bu hastalarda mortalite yüksek olabilmektedir. NIV başarısı, PaO2/FiO2 oranı 100’ün altında geçirilen süre ve serum albumin düşüklüğü hastalık şiddeti ve mortalite belirteci olarak bulunmuştur.

Characteristics of influenza pneumonia patients admitted to the icu due to hypoxemic respiratory failure

Introduction: Hypoxemic respiratory failure due to influenza pneumonia during epidemic seasons sometimes may require mechanical ventilation support and intensive care unit (ICU) stay. We aimed to evaluate the characteristics and risk factors of influenzapneumonia patients admitted to our ICU due to hypoxemic respiratory failure.Materials and Methods: Patients admitted to our ICU between December 2015 and March 2016 who had hypoxemic respiratoryfailure due to clinically and radiologically suspected influenza pneumonia were enrolled.Results: Twenty two patients (11 male) met the enrollment criteria. Median age and APACHE II score was 45 (36-63) years and 19(13-25) respectively. Maximum set PEEP levels during mechanical ventilation was significantly lower in patients who survived [10(8-10) vs 13 (10-16), p= 0.025)]. Deceased patients spent more time under a PaO2/FiO2 ratio below 100 [72 (24-90) vs. 0 (0-48)hours, p= 0.024]. Survival rate was 88% (7/8) in patients who had noninvasive ventilation (NIV) success while it was only 7% (1/14)in patients who had undergone invasive mechanical ventilation (p< 0.001). Overall mortality was 64%.Conclusion: Viral pneumonia may result in severe hypoxemic respiratory failure and ARDS especially during epidemic seasons. NIVsuccess, time spent under a PaO2/FiO2 ratio below 100 and low serum albumin levels at admission may be predictors of severity ofthe disease and mortality.

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