Latest developments in early diagnosis and specific treatment of severe influenza infection  

作　　者：Francisco Valenzuela-Sánchez Blanca Valenzuela-Méndez Juan Francisco Rodríguez-Gutiérrez Ángel Estella 

机构地区：[1]Intensive Care Unit,University Hospital of Jerez,Ronda de Circunvalación s/n,Jerez de la Frontera,Spain [2]Haematology Department,University Hospital of Jerez,Ronda de Circunvalación s/n,Jerez de la Frontera,Spain [3]Centro de Investigación Biomédica en Red,Enfermedades respiratorias,CIBERES,Instituto de Salud Carlos III,Av.de Monforte de Lemos,Madrid,Spain [4]Department of Oncological Surgery,Institut du Cancer de Montpellier(ICM),Parc Euromédecine,208 Av.des Apothicaires,Montpellier,France [5]Department of Medicine,Faculty of Medicine,University of Cádiz,Calle Doctor Marañón,Cádiz,Spain [6]Instituto de Investigación e Innovación Biomédica de Cádiz(INIBiCA),Avenida Ana de Viya 21,Cádiz,Spain

出　　处：《Journal of Intensive Medicine》2024年第2期160-174,共15页重症医学（英文）

摘　　要：Influenza pandemics are unpredictable recurrent events with global health,economic,and social consequences.The objective of this review is to provide an update on the latest developments in early diagnosis and specific treatment of the disease and its complications,particularly with regard to respiratory organ failure.Despite advances in treatment,the rate of mortality in the intensive care unit remains approximately 30%.Therefore,early identification of potentially severe viral pneumonia is extremely important to optimize treatment in these patients.The pathogenesis of influenza virus infection depends on viral virulence and host response.Thus,in some patients,it is associated with an excessive systemic response mediated by an authentic cytokine storm.This process leads to severe primary pneumonia and acute respiratory distress syndrome.Initial prognostication in the emergency department based on comorbidities,vital signs,and biomarkers(e.g.,procalcitonin,ferritin,human leukocyte antigen-DR,mid-regional proadrenomedullin,and lactate)is important.Identification of these biomarkers on admission may facilitate clinical decision-making to determine early admission to the hospital or the intensive care unit.These decisions are reached considering pathophysiological circumstances that are associated with a poor prognosis(e.g.,bacterial co-infection,hyperinflammation,immune paralysis,severe endothelial damage,organ dysfunction,and septic shock).Moreover,early implementation is important to increase treatment efficacy.Based on a limited level of evidence,all current guidelines recommend using oseltamivir in this setting.The possibility of drug resistance should also be considered.Alternative options include other antiviral drugs and combination therapies with monoclonal antibodies.Importantly,it is not recommended to use corticosteroids in the initial treatment of these patients.Furthermore,the implementation of supportive measures for respiratory failure is essential.Current recommendations are limited,heterogeneous,an

关 键 词：INFLUENZA PANDEMIC Respiratory failure Acute respiratory distress syndrome Intensive care unit admission 

分 类 号：R459.7[医药卫生—急诊医学]