BACKGROUND Severe pulmonary infections are among the most common reasons for admission to intensive care units (ICU). Within the last decade, increasing reports of severe influenza pneumonia resulting in acute respiratory distress syndrome (ARDS) complicated by Aspergillus infection were published. OBJECTIVES To provide a comprehensive review of management of influenza-associated pulmonary aspergillosis in patients with ARDS. SOURCES Review of the literature pertaining to severe influenza-associated pulmonary aspergillosis. PubMed database was searched for publications from the database inception to January 2019. CONTENT In patients with lower respiratory symptoms, development of respiratory insufficiency should trigger rapid and thorough clinical evaluation, in particular in cases of suspected ARDS, including electrocardiography and echocardiography to exclude cardiac dysfunction, arrhythmias and ischaemia. Bronchoalveolar lavage should obtain lower respiratory tract samples for galactomannan assay, direct microscopy, culture, and bacterial, fungal and viral PCR. In case of positive Aspergillus testing, chest CT is the imaging modality of choice. If influenza pneumonia is diagnosed, neuraminidase inhibitors are the preferred approved drugs. When invasive aspergillosis is confirmed, first-line therapy consists of isavuconazole or voriconazole. Isavuconazole is an alternative in case of intolerance to voriconazole, drug-drug interactions, renal impairment, or if a spectrum of activity including the majority of Mucorales is desired. Primary anti-mould prophylaxis with posaconazole is recommended in haematology patients at high-risk. It may be considered in newly diagnosed influenza and ARDS, but ideally in clinical trials. IMPLICATIONS The rising reports of influenza-associated pulmonary aspergillosis in patients with ARDS, who are otherwise not considered at risk for fungal pneumonia demands heightened clinical awareness. Tracheobronchitis and Aspergillus in respiratory tract samples should prompt suspicion of invasive fungal infection and further work-up. The management algorithm should comprise bronchoalveolar lavage, CT imaging, sophisticated ventilator-management, rescue extracorporeal membrane oxygenation, and antifungal and antiviral therapy. To decrease the burden of influenza-related illness, vaccination is of utmost importance, specifically in patients with co-morbidities.

中文翻译：

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流感相关的肺曲霉病的重症监护管理。

背景技术严重的肺部感染是重症监护病房（ICU）入院的最常见原因。在过去的十年中，越来越多的报告表明，严重的流感性肺炎导致并发曲霉菌感染的急性呼吸窘迫综合征（ARDS）。目的对ARDS患者中与流感相关的肺曲霉病的处理提供全面的综述。来源有关严重流感相关的肺曲霉病的文献综述。从PubMed数据库创建到2019年1月，一直在PubMed数据库中进行搜索。内容对于呼吸系统症状较轻的患者，呼吸功能不全的发生应触发快速而全面的临床评估，尤其是在疑似ARDS的情况下，包括心电图和超声心动图，以排除心脏功能障碍，心律不齐和局部缺血。支气管肺泡灌洗液应获取下呼吸道样品，以进行半乳甘露聚糖测定，直接显微镜检查，培养以及细菌，真菌和病毒PCR。如果曲霉菌检测呈阳性，则胸部CT是首选的成像方式。如果确诊为流感性肺炎，则神经氨酸酶抑制剂是首选的批准药物。当确诊为侵袭性曲霉病时，一线疗法由依沙康康唑或伏立康唑组成。如果对伏立康唑不耐受，药物-药物相互作用，肾功能不全或需要包括大部分Mucorales的活性谱，则使用Isavuconazole。对于高危血液病患者，建议使用泊沙康唑进行一级抗霉菌预防。在新诊断的流感和ARDS中可以考虑使用它，但在临床试验中最好使用它。后果关于ARDS患者中与流感相关的肺曲霉病的报道不断增加，否则就不认为它们具有真菌性肺炎的风险，因此需要提高临床认识。呼吸道样本中的气管支气管炎和曲霉菌应提示怀疑为侵袭性真菌感染并进一步检查。管理算法应包括支气管肺泡灌洗，CT成像，复杂的呼吸机管理，抢救体外膜氧合以及抗真菌和抗病毒治疗。为了减轻流感相关疾病的负担，接种疫苗至关重要，特别是对于合并症患者。后果关于ARDS患者中与流感相关的肺曲霉病的报道不断增加，否则就不认为它们具有真菌性肺炎的风险，因此需要提高临床认识。呼吸道样本中的气管支气管炎和曲霉菌应提示怀疑为侵袭性真菌感染并进一步检查。管理算法应包括支气管肺泡灌洗，CT成像，复杂的呼吸机管理，抢救体外膜氧合以及抗真菌和抗病毒治疗。为了减轻流感相关疾病的负担，接种疫苗至关重要，特别是对于合并症患者。后果关于ARDS患者中与流感相关的肺曲霉病的报道不断增加，否则就不认为它们具有真菌性肺炎的风险，因此需要提高临床认识。呼吸道样本中的气管支气管炎和曲霉菌应提示怀疑为侵袭性真菌感染并进一步检查。管理算法应包括支气管肺泡灌洗，CT成像，复杂的呼吸机管理，抢救体外膜氧合以及抗真菌和抗病毒治疗。为了减轻流感相关疾病的负担，接种疫苗至关重要，特别是对于合并症患者。否则被认为没有真菌性肺炎风险的人需要提高临床认识。呼吸道样本中的气管支气管炎和曲霉菌应提示怀疑为侵袭性真菌感染并进一步检查。管理算法应包括支气管肺泡灌洗，CT成像，复杂的呼吸机管理，抢救体外膜氧合以及抗真菌和抗病毒治疗。为了减轻流感相关疾病的负担，接种疫苗至关重要，特别是对于合并症患者。否则被认为没有真菌性肺炎风险的人需要提高临床认识。呼吸道样本中的气管支气管炎和曲霉菌应提示怀疑为侵袭性真菌感染并进一步检查。管理算法应包括支气管肺泡灌洗，CT成像，复杂的呼吸机管理，抢救体外膜氧合以及抗真菌和抗病毒治疗。为了减轻流感相关疾病的负担，接种疫苗至关重要，特别是对于合并症患者。抢救体外膜氧合作用，以及抗真菌和抗病毒治疗。为了减轻流感相关疾病的负担，接种疫苗至关重要，特别是对于合并症患者。抢救体外膜氧合，以及抗真菌和抗病毒治疗。为了减轻流感相关疾病的负担，接种疫苗至关重要，特别是对于合并症患者。