PRELIMINARY EXPERIENCE OF THE CLINICAL AND TOMOGRAPHIC CHARACTERISTICS OF PATIENTS WITH NON-REFRACTORY ACUTE RESPIRATORY INSUFFICIENCY CAUSED BY H1N1 INFLUENZA A VIRUS INFECTION AND INTERVENTION OF DISEASE.

Abstract

IntroductionThe HIN1 Influenza A virus infection has a rapid spread worldwide, and although it is believed to have a low mortality rate, one the virus reaches the acute refractory respiratory insufficiency phase, the mortality rate increases drastically. Materials and MethodsIn this study we report the results of 10 clinical case studies of patients who arrived at the emergency room of the Military Hospital located in Guayaquil, Ecuador during the months of July 22, 2009 through September 11, 2009. Upon arrival the patients presented signs and symptoms of acute respiratory insufficiency and were positive for the H1N1 Influenza A virus. The data presented in this paper emphasises the clinical manifestations, arterial blood gas analysis and high resolution computerized tomography (HRCT) findings. computerized tomography findings (HRCT). Result: The characteristics of the patients studied were the following: Mean age of 28.5 +/15.4 SD. The mean time of patient hospitalization was 12.5 days +/10.9 SD. The mean values of Interleukin 6 were: 17,8 +/9.9 SD. The mean level of SaO2% was 91.3 +/2.5 SD. The mean values for respiratory rate were 28.8 +/-4.2 SD. The mean level of arterial pH was 7.35 +/0.06 SD. The mean values of arterial PCO2 were 40.75 +/7.99 SD. The mean values of arterial PO2 were 59.99 +/9.36 and the mean values of arterial H3CO were 22.06 +/5.28. The most frequent findings on high resolution computerized tomography findings were: thickening of the peribronchovascular space (90%), followed by intralobular septa thickening (50%), subpleural septa thickening (30%), bronchioectasis (40%), mosaic image of perfusion (40%) and pulmonary condensation zones (30%). Two patients required non-invasive mechanical ventilation which was set to low exhaled tidal volume of 200mL for the patient weighing 42kg and 300mL for the patient weighing 60kg. We believe that the findings on the HRCT in these patients represent a precocious interstitial lung lesion; for which we consider that an early intervention could prevent the disease progression and the onset of the refractory phase that subsequently leads to hypoxemia and diffuse alveolar damage