RATIONALE: The rapid spread of the 2009 Influenza A (H1N1) around the world underscores the need for a better knowledge of epidemiology, clinical features, outcomes, and mortality predictors, especially in the most severe presentations. OBJECTIVES: To describe these characteristics in patients with confirmed, probable, and suspected viral pneumonia caused by 2009 influenza A (H1N1) admitted to 35 intensive care units with acute respiratory failure requiring mechanical ventilation in Argentina, between June 3 and September 7. METHODS: Inception-cohort study including 337 consecutive adult patients. Data were collected in a form posted on the Argentinian Society of Intensive Care website. MEASUREMENTS AND MAIN RESULTS: Proportions of confirmed, probable, or suspected cases were 39%, 8%, and 53% and had similar outcomes. APACHE II was 18 +/- 7; age 47 +/- 17 years; 56% were male; and 64% had underlying conditions, with obesity (24%), chronic obstructive respiratory disease (18%), and immunosupression (15%) being the most common. Seven percent were pregnant. On admission, patients had severe hypoxemia (Pa(O(2))/Fi(O(2)) 140 [87-200]), extensive lung radiologic infiltrates (2.87 +/- 1.03 quadrants) and bacterial coinfection, (25%; mostly with Streptococcus pneumoniae). Use of adjuvants such as recruitment maneuvers (40%) and prone positioning (13%), and shock (72%) and acute kidney injury requiring hemodialysis (17%), were frequent. Mortality was 46%, and was similar across all ages. APACHE II, lowest Pa(O(2))/Fi(O(2)), shock, hemodialysis, prone positioning, and S. pneumoniae coinfection independently predicted death. CONCLUSIONS: Patients with 2009 influenza A (H1N1) requiring mechanical ventilation were mostly middle-aged adults, often with comorbidities, and frequently developed severe acute respiratory distress syndrome and multiorgan failure requiring advanced organ support. Case fatality rate was accordingly high.
RATIONALE: The rapid spread of the 2009 Influenza A (H1N1) around the world underscores the need for a better knowledge of epidemiology, clinical features, outcomes, and mortality predictors, especially in the most severe presentations. OBJECTIVES: To describe these characteristics in patients with confirmed, probable, and suspected viral pneumonia caused by 2009 influenza A (H1N1) admitted to 35 intensive care units with acute respiratory failure requiring mechanical ventilation in Argentina, between June 3 and September 7. METHODS: Inception-cohort study including 337 consecutive adult patients. Data were collected in a form posted on the Argentinian Society of Intensive Care website. MEASUREMENTS AND MAIN RESULTS: Proportions of confirmed, probable, or suspected cases were 39%, 8%, and 53% and had similar outcomes. APACHE II was 18 +/- 7; age 47 +/- 17 years; 56% were male; and 64% had underlying conditions, with obesity (24%), chronic obstructive respiratory disease (18%), and immunosupression (15%) being the most common. Seven percent were pregnant. On admission, patients had severe hypoxemia (Pa(O(2))/Fi(O(2)) 140 [87-200]), extensive lung radiologic infiltrates (2.87 +/- 1.03 quadrants) and bacterial coinfection, (25%; mostly with Streptococcus pneumoniae). Use of adjuvants such as recruitment maneuvers (40%) and prone positioning (13%), and shock (72%) and acute kidney injury requiring hemodialysis (17%), were frequent. Mortality was 46%, and was similar across all ages. APACHE II, lowest Pa(O(2))/Fi(O(2)), shock, hemodialysis, prone positioning, and S. pneumoniae coinfection independently predicted death. CONCLUSIONS:Patients with 2009 influenza A (H1N1) requiring mechanical ventilation were mostly middle-aged adults, often with comorbidities, and frequently developed severe acute respiratory distress syndrome and multiorgan failure requiring advanced organ support. Case fatality rate was accordingly high.
Authors: Adrienne G Randolph; Frances Vaughn; Ryan Sullivan; Lewis Rubinson; B Taylor Thompson; Grace Yoon; Elizabeth Smoot; Todd W Rice; Laura L Loftis; Mark Helfaer; Allan Doctor; Matthew Paden; Heidi Flori; Christopher Babbitt; Ana Lia Graciano; Rainer Gedeit; Ronald C Sanders; John S Giuliano; Jerry Zimmerman; Timothy M Uyeki Journal: Pediatrics Date: 2011-11-07 Impact factor: 7.124
Authors: Nancy Santesso; Jonathan Hsu; Reem Mustafa; Jan Brozek; Yao Long Chen; Jessica P Hopkins; Adrienne Cheung; Gayane Hovhannisyan; Liudmila Ivanova; Signe A Flottorp; Ingvil Saeterdal; Arthur D Wong; Jinhui Tian; Timothy M Uyeki; Elie A Akl; Pablo Alonso-Coello; Fiona Smaill; Holger J Schünemann Journal: Influenza Other Respir Viruses Date: 2013-09 Impact factor: 4.380
Authors: Jonathan Hsu; Nancy Santesso; Reem Mustafa; Jan Brozek; Yao Long Chen; Jessica P Hopkins; Adrienne Cheung; Gayane Hovhannisyan; Liudmila Ivanova; Signe A Flottorp; Ingvil Saeterdal; Arthur D Wong; Jinhui Tian; Timothy M Uyeki; Elie A Akl; Pablo Alonso-Coello; Fiona Smaill; Holger J Schünemann Journal: Ann Intern Med Date: 2012-02-27 Impact factor: 25.391
Authors: J S Nguyen-Van-Tam; P J M Openshaw; A Hashim; E M Gadd; W S Lim; M G Semple; R C Read; B L Taylor; S J Brett; J McMenamin; J E Enstone; C Armstrong; K G Nicholson Journal: Thorax Date: 2010-07 Impact factor: 9.139