12 Aug 2013

H7N9, Beijing: Hebei patient died of multi-organ failures (Health Dept., August 12 2013, edited)

[Source: Municipality of Beijing Department of Health, full page in Chinese: (LINK). Automatic translation.]

H7N9, Beijing: Hebei patient died of multi-organ failures

Time :2013 -08-12 Source: Beijing Municipal Health Bureau

After 25 days of rescue and Hebei to Beijing for medical treatment of people infected with H7N9 avian influenza in patients with severe, although once respiratory function improved, but in the end due to infection increased, died of multiple organ failure on the evening of 11 August 2013 22:00 about death.

This case development and evolution of the disease and treatment process on the future treatment of human infection with H7N9 avian influenza severe cases have important implications.

Patients Zhang, female, 61 years old, living in Langfang City, Hebei Province, for "five days fever, cough, dyspnea two days" on at 18:00 on July 18, 2013 by Langfang City 120 go to Beijing Chaoyang Hospital. The patient was admitted to hospital, his condition deteriorated rapidly, admissions doctors based on patient characteristics fever and respiratory symptoms, the hospital expert consultation, and rapidly carry out the new flu virus checks and by the Beijing-level expert consultation in July 2013 the 20th confirmed human infection of H7N9 avian influenza in severe cases. The patients with concomitant acute respiratory distress syndrome, severe sepsis, acute renal failure, disseminated intravascular coagulation, and other serious complications.

Beijing Chaoyang Hospital, set up headed by a vice president of the medical treatment group of experts, to carry out treatment. During the period of rapid progression, unstable vital signs, repeatedly issued to the families of patients in critical condition notice. The full treatment, after 1 August 2013 the patient was once signs of improvement in respiratory function, August 4 from the ventilator can be intermittent after spontaneous breathing function recovery exercise, infection was part of the control, consciousness regained conscious, you can eat water.

August 9 review H7N9 virus nucleic acid test results were negative, indicating the effect of antiviral therapy.

Aug. 10 patients with recurrence of infection increased, August 11 quickly developed into sepsis, septic shock, leading to multiple organ failure. At 21:00 on August 11th, patients with decreased heart rate, blood pressure can not be maintained, 21:22 heart rate drops to 0, respiratory arrest, blood pressure is 0, the active rescue, breathing, heartbeat is still not restored, died at 22:01 declared clinically dead. Death diagnose human infection of avian influenza H7N9 pneumonia (severe cases), acute respiratory distress syndrome, acute renal failure, septic shock.

August 12 morning, the Beijing Chaoyang Hospital, organize experts to death were discussed. Experts believe that: The patient's condition improved in the course of severe pneumonia increased again, the rapid development of sepsis, septic shock, leading to multiple organ failure, although the rescue, and finally failed to save lives.

The case where the process of evolution and progression of human infection with H7N9 avian influenza on severe cases have three inspirations:

First, anti-viral treatment for people infected with H7N9 avian influenza remains critically ill patients is necessary also effective. The patients with severe human infection of H7N9 avian influenza patients, but after antiviral therapy viral stock has been effectively controlled, the final test result is negative, combined with extracorporeal membrane oxygenation (artificial lung) applications, once signs of improvement in respiratory function, so human infection with H7N9 avian influenza on critically ill patients to be active antiretroviral therapy.

Second, except for the treatment of severe cases concern the treatment of viral infection, attention should also be multi-organ protection and support to improve the overall success rate. The early onset patients with acute renal failure, have not been able to break away hemofiltration, and ultimately the development of multiple organ failure, indicating that the avian flu patients with severe multiple organ will be hit hard, with severe human infection with the H7N9 avian flu is always there life-threatening.

Three for severe cases, conventional mechanical ventilatory support in difficult circumstances, the timely application of extracorporeal membrane oxygenation (artificial lung) therapy is effective measures.

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