World Journal of Emergency Medicine ›› 2018, Vol. 9 ›› Issue (2): 118-124.doi: 10.5847/wjem.j.1920-8642.2018.02.006
• Original Articles • Previous Articles Next Articles
Hui Xie, Zhi-gang Zhou, Wei Jin, Cheng-bin Yuan, Jiang Du, Jian Lu, Rui-lan Wang()
Received:
2017-05-08
Online:
2018-06-15
Published:
2018-06-15
Contact:
Rui-lan Wang
E-mail:wangyusun@hotmail.com
Hui Xie, Zhi-gang Zhou, Wei Jin, Cheng-bin Yuan, Jiang Du, Jian Lu, Rui-lan Wang. Ventilator management for acute respiratory distress syndrome associated with avian influenza A (H7N9) virus infection: A case series[J]. World Journal of Emergency Medicine, 2018, 9(2): 118-124.
Add to citation manager EndNote|Ris|BibTeX
URL: http://wjem.com.cn//EN/10.5847/wjem.j.1920-8642.2018.02.006
Table 1
Clinical characteristics of 8 patients infected with H7N9 virus
Parameters | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
---|---|---|---|---|---|---|---|---|
Age (year) | 61 | 35 | 54 | 34 | 72 | 62 | 58 | 83 |
Sex | Female | Male | Male | Male | Male | Female | Male | Female |
Underlying conditions | Hypertension | / | / | / | Hypertension | / | Cerebellar hemorrhage, cirrhosis | Hypertension, diabetes, atrial fibrillation |
APACHE II | 19.25±6.34 | 8.25±2.06 | 11.00±3.37 | 8.50±3.00 | 8.25±2.63 | 9.00±2.58 | 8.50±1.91 | 24.67±2.31 |
SOFA | 12.00±2.82 | 6.25±0.96 | 6.75±0.96 | 6.75±1.50 | 5.25±1.71 | 6.00±1.15 | 6.50±1.29 | 13.67±0.58 |
Complications | ||||||||
Acute renal damage | Yes | No | No | No | No | No | No | No |
Rhabdomyolysis | Yes | Yes | Yes | Yes | Yes | No | No | Yes |
Encephalopathy | Yes | No | No | No | No | No | No | No |
Secondary infections | No | Yes | Yes | Yes | No | No | Yes | Yes |
Stphylococcus epidermidis | Staphylococcus haemolyticus, pseudomonas aeruginosa | Staphylococcus aureus | Staphylococcus aureus | Candida albicans, Candida tropicalis | ||||
Duration of MV (days) | 20 | 20 | 25 | 13 | 7 | 13 | 11 | 9 |
Prone position of MV (days) | 2 | / | / | 2 | / | / | / | / |
Recruitment maneuvers | Yes | Yes | Yes | Yes | No | No | No | No |
Continuous renal replacement therapy (CRRT) | Yes | No | No | No | No | No | No | No (abandoned) |
Antibiotic therapy | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Antiviral agent | Oseltamivir | Oseltamivir | Oseltamivir | Oseltamivir | Oseltamivir | Oseltamivir | Oseltamivir | Oseltamivir |
Glucocorticoid therapy | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Intravenous immune globulin therapy | Yes | Yes | Yes | No | No | Yes | Yes | Yes |
Anticoagulation | LMW Heparins | LMW Heparins | LMW Heparins | LMW Heparins | LMW Heparins | LMW Heparins | / | LMW Heparins |
Length of stay in ICU (days) | 20 | 30 | 25 | 20 | 15 | 15 | 41 | 11 |
Length of stay in hospital (days) | 20 | 40 | 25 | 27 | 25 | 27 | 41 | 11 |
Outcome | Died | Survived | Died | Survived | Survived | Survived | Survived | Died |
Table 2
CT findings in 8 patients infected with H7N9 virus, n (%)
CT findings | Patients (n=8) |
---|---|
Architectural distortion | 8 (100) |
Traction bronchiolectasis | 6 (75) |
Traction bronchiectasis | 6 (75) |
Intralobular septal thickening | 4 (50) |
Interlobular septal thickening | 7 (87) |
Honeycombing | 1 (12.5) |
Ground-glass attenuation | 8 (100) |
Air-space consolidation | 8 (100) |
Table 3
Extent of each CT finding in 8 patients infected with H7N9 virus
Parameters | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | Mean±SD |
---|---|---|---|---|---|---|---|---|---|
The Murray's score at the first CT examination | 3.67 | 3.25 | 2.75 | 2.75 | 3.25 | 3.33 | 2.5 | 2.5 | 2.97±1.03 |
The CT score at the first CT examination | 260.9 | 240.4 | 294.7 | 207.6 | 240.4 | 196.3 | 255.7 | 285.4 | 247.68±34.28 |
Spared area (%) | 26.0 | 17.0 | 33.5 | 55.3 | 35.2 | 60.0 | 24.5 | 25.6 | 34.64±15.32 |
Ground-glass attenuation (%) | 22.4 | 32.6 | 6.5 | 10.2 | 10.5 | 10.5 | 18.6 | 24 | 16.91±8.98 |
Air-space consolidation (%) | 31.3 | 46.9 | 13.5 | 17.2 | 42.4 | 16.1 | 40 | 6.4 | 26.73±15.31 |
Ground-glass attenuation + traction bronchiolectasis or bronchiectasis (%) | 5.3 | 0 | 24.8 | 6.2 | 2.5 | 0 | 10.5 | 30.4 | 9.96±11.52 |
Air-space consolidation + traction bronchiolectasis or bronchiectasis (%) | 15.0 | 3.5 | 21.7 | 11.1 | 9.4 | 13.4 | 6.4 | 10.6 | 11.39±5.54 |
Honeycombing (%) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 3 | 0.375±1.06 |
Figure 3.
Illustration of PEEP induced lung recruitment detected by bedside ultrasound in patient 2. A: The images of upper part of anterior region of left chest wall before and after RM. Left: Transversal view of a lung region with alveolar syndrome. Multiple well-defined B lines (B1 lines) arising from the pleural line are present. Right: After RM, the same lung region appears normally aerated. The pleural line can be seen. B: The images of upper part of anterior region of right chest wall before and after RM. Left: Coalescent B lines (B2 lines) arising from the pleural lineare present. Right: After RM, the same lung region appears normally aerated. The pleural line can be seen with two isolated B lines. These artifacts correspond to ground-glass areas on chest computed tomography. C: The images of lower part of lateral region of right chest wall before and after RM. Left: Transversal view of consolidated right lobe. Lung consolidation appears as a tissue structure can be seen. Right: After RM, the same lung region appears normally aerated. The pleural line can be seen with an isolated B line. These artifacts correspond to air-space consolidation areas on chest computed tomography.
Table 4
Extent of each CT finding in 8 patients infected with H7N9 virus
Parameters | 1 | 2 | 3 | 4 |
---|---|---|---|---|
Ultrasound reaeration score | +7 | +10 | +11 | +6 |
PEEP before RM (cmH2O) | 16 | 30 | 10 | 14 |
FiO2 before RM (%) | 100 | 100 | 100 | 100 |
PaO2/FiO2 ratio | ||||
Before RM | 71 | 114 | 50 | 110 |
After RM (20 minutes) | 93 | 220 | 191 | 125 |
PaO2/FiO2 increase (%) | 30.99 | 92.98 | 282 | 13.64 |
Lung recruitment measured with the PV curve (mL) | 468 | 706 | 830 | 338 |
1 | To KK, Chan JF, Chen H, Li L, Yuen KY. The emergence of influenza A H7N9 in human beings 16 years after influenza A H5N1: a tale of two cities. Lancet Infect Dis. 2013;13(9):809-21. |
2 |
Poovorawan Y. Epidemic of avian influenza A (H7N9) virus in China. Pathog Glob Health. 2014;108(4):169-70.
doi: 10.1179/2047772414Z.000000000206 pmid: 24954879 |
3 |
Lin ZQ, Xu XQ, Zhang KB, Zhuang ZG, Liu XS, Zhao LQ, et al. Chest X-ray and CT findings of early H7N9 avian influenza cases. Acta Radiol. 2015;56(5):552-6.
doi: 10.1177/0284185114535209 pmid: 24917607 |
4 |
Tsai NW, Ngai CW, Mok KL, Tsung JW. Lung ultrasound imaging in avian influenza A (H7N9) respiratory failure. Crit Ultrasound J. 2014;6(1):6.
doi: 10.1186/2036-7902-6-6 pmid: 24949191 |
5 |
Gao HN, Lu HZ, Cao B, Du B, Shang H, Gan JH, et al. Clinical findings in 111 cases of influenza A (H7N9) virus infection. N Engl J Med. 2013;368(24):2277-85.
doi: 10.1056/NEJMoa1305584 pmid: 23697469 |
6 |
Yu H, Cowling BJ, Feng L, Lau EH, Liao Q, Tsang TK, et al. Human infection with avian influenza A H7N9 virus: an assessment of clinical severity. Lancet. 2013;382(9887):138-45.
doi: 10.1016/S0140-6736(13)61207-6 |
7 |
Uyeki TM, Cox NJ. Global concerns regarding novel influenza A (H7N9) virus infections. N Engl J Med. 2013;368(20):1862-4.
doi: 10.1056/NEJMp1304661 pmid: 23577629 |
8 |
Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526-33.
doi: 10.1001/jama.2012.5669 pmid: 22797452 |
9 |
Girgis K, Hamed H, Khater Y, Kacmarek RM. A decremental PEEP trial identifies the PEEP level that maintains oxygenation after lung recruitment. Respiratory Care. 2006;51(10):1132-9.
pmid: 17005058 |
10 |
Guerin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368(23):2159-68.
doi: 10.1056/NEJMoa1214103 pmid: 23688302 |
11 |
Bouhemad B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby JJ. Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med. 2011;183(3):341-7.
doi: 10.1164/rccm.201003-0369OC pmid: 20851923 |
12 |
Bouhemad B, Liu ZH, Arbelot C, Zhang M, Ferarri F, Le-Guen M, et al. Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med. 2010;38(1):84-92.
doi: 10.1097/CCM.0b013e3181b08cdb pmid: 19633538 |
13 |
Ichikado K, Johkoh T, Ikezoe J, Takeuchi N, Kohno N, Arisawa J, et al. Acute interstitial pneumonia: high-resolution CT findings correlated with pathology. AJR Am J Roentgenol. 1997;168(2):333-8.
doi: 10.2214/ajr.168.2.9016201 pmid: 9016201 |
14 |
Ichikado K, Suga M, Muller NL, Taniguchi H, Kondoh Y, Akira M, et al. Acute interstitial pneumonia: comparison of high-resolution computed tomography findings between survivors and nonsurvivors. Am J Respir Crit Care Med. 2002;165(11):1551-6.
doi: 10.1164/rccm.2106157 pmid: 12045132 |
15 |
Ichikado K, Suga M, Muranaka H, Gushima Y, Miyakawa H, Tsubamoto M, et al. Prediction of prognosis for acute respiratory distress syndrome with thin-section CT: validation in 44 cases. Radiology. 2006;238(1):321-9.
doi: 10.1148/radiol.2373041515 pmid: 16293804 |
16 | Guideline on prevention and control of H7N9 avian influenza human infection. J Thorac Dis. 2013;5 Suppl 2:S168-72. |
17 |
W.H. Organization, Overview of the emergence and characteristics of the avian influenza A(H7N9) virus. Available at: http://www.who.int/influenza/human_animal_interface/influenza_h7n9/WHO_H7N9_review_31May13.pdf, Accessed 1 June 2013.
doi: 10.1016/S1701-2163(16)34855-1 pmid: 21501542 |
18 |
Yu L, Wang Z, Chen Y, Ding W, Jia H, Chan JF, et al. Clinical, virological, and histopathological manifestations of fatal human infections by avian influenza A(H7N9) virus. Clin Infect Dis. 2013;57(10):1449-57.
doi: 10.1093/cid/cit541 |
19 |
To KK, Hung IF, Li IW, Lee KL, Koo CK, Yan WW, et al. Delayed clearance of viral load and marked cytokine activation in severe cases of pandemic H1N1 2009 influenza virus infection. Clin Infect Dis. 2010;50(6):850-9.
doi: 10.1086/650581 pmid: 20136415 |
20 |
Zhang Z, Zhang J, Huang K, Li KS, Yuen KY, Guan Y, et al. Systemic infection of avian influenza A virus H5N1 subtype in humans. Hum Pathol. 2009;40(5):735-9.
doi: 10.1016/j.humpath.2008.08.015 |
21 |
Korteweg C, Gu J. Pathology, molecular biology, and pathogenesis of avian influenza A (H5N1) infection in humans. Am J Pathol. 2008;172(5):1155-70.
doi: 10.2353/ajpath.2008.070791 pmid: 18403604 |
22 |
Serpa Neto A, Cardoso SO, Manetta JA, Pereira VG, Esposito DC, Pasqualucci Mde O, et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA. 2012;308(16):1651-9.
doi: 10.1001/jama.2012.13730 pmid: 23093163 |
23 |
Terragni PP, Del Sorbo L, Mascia L, Urbino R, Martin EL, Birocco A, et al. Tidal volume lower than 6 ml/kg enhances lung protection: role of extracorporeal carbon dioxide removal. Anesthesiology. 2009;111(4):826-35.
doi: 10.1097/ALN.0b013e3181b764d2 pmid: 19741487 |
24 |
Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301-8.
doi: 10.1056/NEJM200005043421801 pmid: 10793162 |
25 |
Ramsey CD, Funk D, Miller RR 3rd, Kumar A. Ventilator management for hypoxemic respiratory failure attributable to H1N1 novel swine origin influenza virus. Crit Care Med. 2010;38(4 Suppl):e58-65.
doi: 10.1097/CCM.0b013e3181cde600 pmid: 20042855 |
26 |
Zhang HW, Wei LY, Zhao G, Yang YJ, Liu SZ, Zhang ZY, et al. Periplaneta americana extract used in patients with systemic inflammatory response syndrome. World J Emerg Med. 2016;7(1):50-4.
doi: 10.5847/wjem.j.1920-8642.2016.01.009 pmid: 27006739 |
27 |
Spieth PM, Gama de Abreu M. Lung recruitment in ARDS: we are still confused, but on a higher PEEP level. Crit Care. 2012; 16(1):108.
doi: 10.1186/cc11177 pmid: 22316169 |
28 |
Nizami MI, Narahari NK, Paramjyothi GK, Sharma A. An unusual cause of simultaneous bilateral spontaneous pneumothorax. World J Emerg Med. 2017;8(1):74-6.
doi: 10.5847/wjem.j.1920-8642.2017.01.015 pmid: 28123627 |
29 |
Wei M, Gong YJ, Tu L, Li J, Liang YH, Zhang YH. Expression of phosphatidylinositol-3 kinase and effects of inhibitor Wortmannin on expression of tumor necrosis factor-α in severe acute pancreatitis associated with acute lung injury. World J Emerg Med. 2015;6(4):299-304.
doi: 10.5847/wjem.j.1920-8642.2015.04.009 pmid: 26693266 |
30 |
Lee JM, Bae W, Lee YJ, Cho YJ. The efficacy and safety of prone positional ventilation in acute respiratory distress syndrome: updated study-level meta-analysis of 11 randomized controlled trials. Crit Care Med. 2014;42(5):1252-62.
doi: 10.1097/CCM.0000000000000122 pmid: 24368348 |
31 |
Beitler JR, Shaefi S, Montesi SB, Devlin A, Loring SH, Talmor D, et al. Prone positioning reduces mortality from acute respiratory distress syndrome in the low tidal volume era: a meta-analysis. Intensive Care Med. 2014;40(3):332-41.
doi: 10.1007/s00134-013-3194-3 pmid: 24435203 |
32 |
Gattinoni L, Vagginelli F, Carlesso E, Taccone P, Conte V, Chiumello D, et al. Decrease in PaCO2 with prone position is predictive of improved outcome in acute respiratory distress syndrome. Crit Care Med. 2003;31(12):2727-33.
doi: 10.1097/01.CCM.0000098032.34052.F9 pmid: 14668608 |
[1] | Zi-wei Ke, Yue Jiang, Ya-ping Bao, Ye-qin Yang, Xiao-mei Zong, Min Liu, Xiang-yun Guan, Zhong-qiu Lu. Intensivists’ response to hyperoxemia in mechanical ventilation patients: The status quo and related factors [J]. World Journal of Emergency Medicine, 2021, 12(3): 202-206. |
[2] | Yu-qing Cui, Xian-fei Ding, Huo-yan Liang, Dong Wang, Xiao-juan Zhang, Li-feng Li, Quan-cheng Kan, Le-xin Wang, Tong-wen Sun. Efficacy and safety of low-dose corticosteroids for acute respiratory distress syndrome: A systematic review and meta-analysis [J]. World Journal of Emergency Medicine, 2021, 12(3): 207-213. |
[3] | Hao-tian Chen, Jian-feng Xu, Xiao-xia Huang, Ni-ya Zhou, Yong-kui Wang, Yue Mao. Blood eosinophils and mortality in patients with acute respiratory distress syndrome: A propensity score matching analysis [J]. World Journal of Emergency Medicine, 2021, 12(2): 131-136. |
[4] | Yi Han, Su-cheng Mu, Jian-li Wang, Wei Wei, Ming Zhu, Shi-lin Du, Min Min, Yun-jie Xu, Zhen-ju Song, Chao-yang Tong. MicroRNA-145 plays a role in mitochondrial dysfunction in alveolar epithelial cells in lipopolysaccharide-induced acute respiratory distress syndrome [J]. World Journal of Emergency Medicine, 2021, 12(1): 54-60. |
[5] | Yu-ming Wang, Yan-jun Zheng, Ying Chen, Yun-chuan Huang, Wei-wei Chen, Ran Ji, Li-li Xu, Zhi-tao Yang, Hui-qiu Sheng, Hong-ping Qu, En-qiang Mao, Er-zhen Chen. Effects of fluid balance on prognosis of acute respiratory distress syndrome patients secondary to sepsis [J]. World Journal of Emergency Medicine, 2020, 11(4): 216-222. |
[6] | Suresh Kumar Arumugam, Insolvisagan Mudali, Gustav Strandvik, Ayman El-Menyar, Ammar Al-Hassani, Hassan Al-Thani. Risk factors for ventilator-associated pneumonia in trauma patients: A descriptive analysis [J]. World Journal of Emergency Medicine, 2018, 9(3): 203-210. |
[7] | Ruo Wu, Shi-yun Lin, Hui-min Zhao. Albuterol in the treatment of acute respiratory distress syndrome: A meta-analysis of randomized controlled trials [J]. World Journal of Emergency Medicine, 2015, 6(3): 165-171. |
[8] | Ze-hua Dong, Bang-xu Yu, Yun-bo Sun, Wei Fang, Lei Li. Effects of early rehabilitation therapy on patients with mechanical ventilation [J]. World Journal of Emergency Medicine, 2014, 5(1): 48-52. |
[9] | Rui-lan Wang, Kan Xu, Kang-long Yu, Xue Tang, Hui Xie. Effects of dynamic ventilatory factors on ventilator-induced lung injury in acute respiratory distress syndrome dogs [J]. World Journal of Emergency Medicine, 2012, 3(4): 287-293. |
[10] | Rong-rong Song, Yan-ping Qiu, Yong-ju Chen, Yong Ji. Application of fiberoptic bronchscopy in patients with acute exacerbations of chronic obstructive pulmonary disease during sequential weaning of invasive-noninvasive mechanical ventilation [J]. World Journal of Emergency Medicine, 2012, 3(1): 29-34. |
[11] | Xiao-yan Wu, Ying-zi Huang, Huo-gen Liu, Dong-ya Huang, Rui Tang, Hai-bo Qiu. Effects of pulmonary stretch reflex on lung injury in rabbits with acute respiratory distress syndrome [J]. World Journal of Emergency Medicine, 2011, 2(4): 296-301. |
[12] | Jian-guo Zhang, Xiao-juan Chen, Fen Liu, Zhen-guo Zeng, Ke-jian Qian. Lung recruitment maneuver effects on respiratory mechanics and extravascular lung water index in patients with acute respiratory distress syndrome [J]. World Journal of Emergency Medicine, 2011, 2(3): 201-205. |
[13] | Huan Huang, Xin-hui Xu, Yi Chen, Li-xiong Lu, Chang-qing Zhu. Early tracheotomy for acute severe asthma [J]. World Journal of Emergency Medicine, 2011, 2(2): 154-156. |
[14] | Zhi-hong Liu, Xin-ri Zhang, Xiao-yun Hu, Meng-yu Cheng, Jian-ying Xu, Yong-cheng Du. Effect of glucocorticoid on MIP-1α and NF-кb expressing in the lung of rats undergoing mechanical ventilation with a high tidal volume [J]. World Journal of Emergency Medicine, 2011, 2(1): 66-69. |
[15] | Yu-feng Chu, Yi Jiang, Mei Meng, Jin-jiao Jiang, Ji-cheng Zhang, Hong-sheng Ren, Chun-ting Wang. Incidence and risk factors of gastrointestinal bleeding in mechanically ventilated patients [J]. World Journal of Emergency Medicine, 2010, 1(1): 32-36. |
Viewed | ||||||
Full text |
|
|||||
Abstract |
|
|||||