J Marin-Corral1, C Climent2, R Muñoz2, M Samper2, I Dot2, C Vilà2, J R Masclans3, A Rodriguez4, I Martin-Loeches5, F Álvarez-Lerma6. 1. Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Grupo de Investigación en Patología Crítica (GREPAC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España. Electronic address: jmarincorral@gmail.com. 2. Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Grupo de Investigación en Patología Crítica (GREPAC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España. 3. Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Grupo de Investigación en Patología Crítica (GREPAC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España. 4. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Servicio de Medicina Intensiva, Hospital Universitario Joan XXIII, Institut d'Investigació Sanitària Pere Virgili (IISPV)-Universitat Rovira i Virgili (URV), Tarragona, España. 5. Service of Intensive Care Medicine, St. James's Hospital, Dublin, Irlanda. 6. Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Grupo de Investigación en Patología Crítica (GREPAC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España.
Abstract
OBJECTIVES: To evaluate the impact of the recommendations of the SEMICYUC (2012) on severe influenza A. DESIGN: A prospective multicenter observational study was carried out. SETTING: ICU. PATIENTS: Patients infected with severe influenza A (H1N1) from the GETGAG/SEMICYUC registry. INTERVENTIONS: Analysis of 2 groups according to the epidemic period of the diagnosis (2009-2011; 2013-2015). VARIABLES: Demographic, temporal, comorbidities, severity, treatments, mortality, late diagnosis and place of acquisition. RESULTS: A total of 2,205 patients were included, 1,337 (60.6%) in the first period and 868 (39.4%) in the second one. Age and severity on admission were significantly greater in the second period, as well as co-infection. With regard to the impact of the recommendations, in the second period the diagnosis was established earlier (70.8 vs. 61.1%, P<.001), without changes in the start of treatment. Patients received less corticosteroid treatment (39.7 vs. 44.9%, P<.05), more NIMV was used (47.4 vs. 33.2%, P<.001) and more vaccination was made (11.1 vs. 1.7%, P<.001), without changes in mortality (24.2 vs. 20.7%). A decrease in nosocomial infection was also noted (9.8 vs. 16%, P<.001). Patients needed less MV with more days of ventilation, more vasopressor drug use and more ventral decubitus. CONCLUSIONS: The management of patients with severe influenza A (H1N1) has changed over the years, though without changes in mortality. The recommendations of the SEMICYUC (2012) have allowed earlier diagnosis and improved corticosteroid use. Pending challenges are the delay in treatment, the vaccination rate and the use of NIMV.
OBJECTIVES: To evaluate the impact of the recommendations of the SEMICYUC (2012) on severe influenza A. DESIGN: A prospective multicenter observational study was carried out. SETTING: ICU. PATIENTS: Patients infected with severe influenza A (H1N1) from the GETGAG/SEMICYUC registry. INTERVENTIONS: Analysis of 2 groups according to the epidemic period of the diagnosis (2009-2011; 2013-2015). VARIABLES: Demographic, temporal, comorbidities, severity, treatments, mortality, late diagnosis and place of acquisition. RESULTS: A total of 2,205 patients were included, 1,337 (60.6%) in the first period and 868 (39.4%) in the second one. Age and severity on admission were significantly greater in the second period, as well as co-infection. With regard to the impact of the recommendations, in the second period the diagnosis was established earlier (70.8 vs. 61.1%, P<.001), without changes in the start of treatment. Patients received less corticosteroid treatment (39.7 vs. 44.9%, P<.05), more NIMV was used (47.4 vs. 33.2%, P<.001) and more vaccination was made (11.1 vs. 1.7%, P<.001), without changes in mortality (24.2 vs. 20.7%). A decrease in nosocomial infection was also noted (9.8 vs. 16%, P<.001). Patients needed less MV with more days of ventilation, more vasopressor drug use and more ventral decubitus. CONCLUSIONS: The management of patients with severe influenza A (H1N1) has changed over the years, though without changes in mortality. The recommendations of the SEMICYUC (2012) have allowed earlier diagnosis and improved corticosteroid use. Pending challenges are the delay in treatment, the vaccination rate and the use of NIMV.
Authors: P Rascado Sedes; M Á Ballesteros Sanz; M A Bodí Saera; L F Carrasco RodríguezRey; Á Castellanos Ortega; M Catalán González; C de Haro López; E Díaz Santos; A Escriba Barcena; M J Frade Mera; J C Igeño Cano; M C Martín Delgado; G Martínez Estalella; N Raimondi; O Roca I Gas; A Rodríguez Oviedo; E Romero San Pío; J Trenado Álvarez; M Raurell Journal: Enferm Intensiva (Engl Ed) Date: 2020-04-03
Authors: P Rascado Sedes; M A Ballesteros Sanz; M A Bodí Saera; L F Carrasco Rodríguez-Rey; A Castellanos Ortega; M Catalán González; C de Haro López; E Díaz Santos; A Escriba Barcena; M J Frade Mera; J C Igeño Cano; M C Martín Delgado; G Martínez Estalella; N Raimondi; O Roca I Gas; A Rodríguez Oviedo; E Romero San Pío; J Trenado Álvarez Journal: Med Intensiva (Engl Ed) Date: 2020-04-23
Authors: Gerard Moreno; Alejandro Rodríguez; Luis F Reyes; Josep Gomez; Jordi Sole-Violan; Emili Díaz; María Bodí; Sandra Trefler; Juan Guardiola; Juan C Yébenes; Alex Soriano; José Garnacho-Montero; Lorenzo Socias; María Del Valle Ortíz; Eudald Correig; Judith Marín-Corral; Montserrat Vallverdú-Vidal; Marcos I Restrepo; Antoni Torres; Ignacio Martín-Loeches Journal: Intensive Care Med Date: 2018-08-03 Impact factor: 17.440