2024年第2期Journal of Intensive Medicine刊发了一篇综述Latest developments in early diagnosis and specific treatment of severe influenza infection。 我们将文章摘要进行翻译，方便大家快速了解文章内容。
Summary:
Influenza pandemics are unpredictable, recurring and have global health, economic and social impacts. This article reviews the latest advances in the early diagnosis and treatment of the disease and its complications, particularly respiratory failure. Despite advances in the treatment of influenza, the mortality rate of influenza patients admitted to intensive care units is still around 30%. Therefore, early identification of patients with potentially severe viral pneumonia is extremely important to optimize the treatment of these patients. The pathogenesis of influenza virus infection depends on the virulence of the virus and the host response. Thus, in some patients, influenza virus infection is associated with an excessive systemic response mediated by the patient's own cytokine storm. This process leads to severe primary pneumonia and acute respiratory distress syndrome. It is important to make an initial assessment of the patient's prognosis in the emergency department based on comorbidities, vital signs, and biomarkers (e.g., procalcitonin, ferritin, human leukocyte antigen-DR, adrenal medullary midsection, and lactate). Monitoring these biomarkers may help make decisions about admission to hospital or intensive care unit. These decisions are made based on the pathophysiological context associated with poor prognosis (e.g., bacterial infection, excessive inflammatory response, immune paralysis, severe endothelial cell damage, organ dysfunction, and septic shock). Early treatment is also important to improve treatment outcomes. Based on limited evidence, all current guidelines recommend oseltamivir in this setting, but consider the possibility of resistance. Alternative options include combinations of other antiviral drugs and monoclonal antibodies. Importantly, the use of corticosteroids in the initial treatment of these patients is not recommended. In addition, support for respiratory failure is crucial. Current recommendations are limited, varied and constantly updated. Early intubation and mechanical ventilation are the basic treatment for patients with severe respiratory failure. Patients with acute respiratory distress syndrome should be aggressively ventilated in the prone position, and early tracheostomy should be considered in patients who may require prolonged mechanical ventilation. To improve patient outcomes, clinical studies should be conducted on antiviral therapy and specific respiratory support measures for these patients and for different populations.
Acknowledgement: Dr. Leung Yu-pang for assisting in the translation
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- Journal of Intensive Medicine是中国科协卓越行动计划支持刊物，中华医学会系列期刊
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Types of Publications: Monographs, Reviews, Reviews, Expert Opinions, Consensus & Guidelines, Systematic Reviews & Meta-Analysis, Letters from Readers
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