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Torres López, Moisés; Sará Ochoa, Jorge; Torres Millan, Juan; Gamarra, Said; Giraldo, Isabel
Acta Colombiana de Cuidado Intensivo, October-December 2015, 2015-10-00, Volume: 15, Issue: 4Journal Article
El virus H1N1 es mutante de la influenza humana, porcina y aviar; ha generado 4 pandemias en los últimos 100 años, la gravedad e incertidumbre para diagnosticarlos hace especial a estos pacientes, muchos de ellos deben manejarse en cuidados intensivos, principalmente por fallo respiratorio. Presentamos 58 pacientes con sospecha de neumonía por H1N1, manejados en cuidados intensivos, pero solo en 11 pacientes se confirmó el diagnóstico. Se evidenció una diferencia significativa en la mediana de la estancia en cuidados intensivos (10 días vs. 3,5 días; p=0,00), cociente de presión arterial de oxígeno/fracción inspirada de oxígeno (114,1 vs. 79; p=0,013), APACHE II (17 vs. 25; p=0,001) y tiempo de síntomas previos a la consulta (8 días vs. 5 días; p=0,007), al comparar el grupo sobrevivientes con fallecidos, respectivamente. El grupo con diagnóstico de H1N1 presentó una mediana significativamente más baja del cociente presión arterial de oxígeno/fracción inspirada de oxígeno, al ingresar a cuidados intensivos (74,3 vs. 112,1; p=0,009). El grupo de pacientes con fallo respiratorio que mueren, presentan un mayor puntaje APACHE II; menor tiempo desde el inicio de los síntomas y la consulta, menor relación PaO2/FiO2, menor tiempo de estancia en la UCI y su procedencia es del área rural. Los pacientes admitidos en la UCI con fallo respiratorio y diagnóstico de H1N1, presentan un cociente de presión arterial de oxígeno/fracción inspirada de oxígeno al ingreso, significativamente menor que en los que no se confirma el diagnóstico. H1N1 virus is a mutant of human, swine, and avian influenza. It has generated 4 pandemics in the last century. The seriousness and uncertainty of the diagnosis makes these patients special, many of whom have to be admitted to the ICU, mainly due to respiratory failure. The cases are presented on 58 pneumonia patients suspected of H1N1 admitted to the ICU. H1N1 diagnosis was confirmed in only 11 of the patients. There was a significant difference in the median stay in the ICU (10 days vs. 3.5 days, P=.00), partial pressure arterial oxygen (PaO2)/fraction inspired oxygen (FiO2) ratio (114.1 vs. 79 P=.013), APACHE II (17 vs. 25, P=.001), and time without symptoms prior to consultation (8 days vs. 5 days, P=.007) when comparing the number of deceased with the number of survivors. The groups with H1N1 diagnosis showed a significantly lower median of PaO2/FiO2 (74.3 vs. 112.1, P=.009) in the ICU. The group of patients with respiratory failure who died showed a higher APACHE II score, less time lapse between the onset of symptoms and consultation, a lower PaO2/FiO2 ratio, a lower stay in the ICU, and they came from rural areas. The patients admitted to the ICU for respiratory failure and a confirmed H1N1 diagnosis show a much lower PaO2/FiO2 ratio than the patients without a confirmed H1N1 diagnosis.
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