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Pediatric Critical Care Medicine:
March 2012 - Volume 13 - Issue 2 - p e78?e83
doi: 10.1097/PCC.0b013e318219266b
Online Clinical Investigations
High mortality in patients with influenza A pH1N1 2009 admitted to a pediatric intensive care unit: A predictive model of mortality*
Torres, Silvio Fabio MD; Iolster, Thomas MD; Schnitzler, Eduardo Julio MD; Farias, Julio Alberto MD; Bordogna, Adriana Claudia MD; Rufach, Daniel MD; Montes, Mar?a Jos? MD; Siaba, Alejandro Javier MD; Rodr?guez, Mar?a Gabriela MD; Jabornisky, Roberto MD; Colman, Carmen MD; Fern?ndez, Analia MD; Caprotta, Gustavo MD; Diaz, Silvia MD; Poterala, Roxana MD; De Meyer, Marcela MD; Penazzi, Mat?as Enrique MD; Gonz?lez, Gustavo MD; Saenz, Silvia MD; Recupero, Oscar MD; Zapico, Luis MD; Alarcon, Blanca MD; Ariel, Esen MD; Minces, Pablo MD; Mari, Eduardo MD; Carnie, Antonio MD; Garea, M?nica MD; Jaen, Roxana MD
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Abstract
Objective: To describe the clinical characteristics and outcome of patients admitted to pediatric intensive care with influenza A (pH1N1) 2009 in Argentina.
Design: Retrospective observational study.
Setting: Thirteen pediatric intensive care units in Argentina.
Subjects: One hundred and forty-two patients with confirmed or suspected influenza A (H1N1).
Interventions: None.
Measurements and Main Results: We included 142 critically ill patients. The median age was 19 months (range, 2?110 months) with 39% of the patients <24 months of age. Ninety-nine patients (70%) had an underlying disease. Influenza A (pH1N1) 2009 infection was confirmed in 90 patients and the remaining 52 had a positive direct immunofluorescence assay for influenza A. The median length of stay in the pediatric intensive care unit was 12 days (range, 2?52 days). One hundred eighteen patients (83%) received invasive mechanical ventilation and 19 patients were treated with noninvasive ventilation; however, seven of the patients receiving noninvasive ventilation later needed mechanical ventilation. Sixty-eight patients died (47%) with the most frequent cause refractory hypoxemia. Multivariate logistic regression analysis showed that age <24 months (odds ratio, 2.87; 2.35?3.93), asthma (odds ratio, 1.34; 1.20?2.91), and respiratory coinfection with respiratory syncytial virus (odds ratio, 2.92; 1.20?4.10) were associated with higher mortality. As expected, mechanical ventilation and treatment with inotropes were also associated with increased mortality.
Conclusions: The mortality of children admitted to the pediatric intensive care unit with 2009 pH1N1 influenza was high (47%) in our population. Age <24 months, asthma, respiratory coinfection, need of mechanical ventilation, and treatment with inotropes were predictors of poorer outcome.
March 2012 - Volume 13 - Issue 2 - p e78?e83
doi: 10.1097/PCC.0b013e318219266b
Online Clinical Investigations
High mortality in patients with influenza A pH1N1 2009 admitted to a pediatric intensive care unit: A predictive model of mortality*
Torres, Silvio Fabio MD; Iolster, Thomas MD; Schnitzler, Eduardo Julio MD; Farias, Julio Alberto MD; Bordogna, Adriana Claudia MD; Rufach, Daniel MD; Montes, Mar?a Jos? MD; Siaba, Alejandro Javier MD; Rodr?guez, Mar?a Gabriela MD; Jabornisky, Roberto MD; Colman, Carmen MD; Fern?ndez, Analia MD; Caprotta, Gustavo MD; Diaz, Silvia MD; Poterala, Roxana MD; De Meyer, Marcela MD; Penazzi, Mat?as Enrique MD; Gonz?lez, Gustavo MD; Saenz, Silvia MD; Recupero, Oscar MD; Zapico, Luis MD; Alarcon, Blanca MD; Ariel, Esen MD; Minces, Pablo MD; Mari, Eduardo MD; Carnie, Antonio MD; Garea, M?nica MD; Jaen, Roxana MD
Collapse Box
Abstract
Objective: To describe the clinical characteristics and outcome of patients admitted to pediatric intensive care with influenza A (pH1N1) 2009 in Argentina.
Design: Retrospective observational study.
Setting: Thirteen pediatric intensive care units in Argentina.
Subjects: One hundred and forty-two patients with confirmed or suspected influenza A (H1N1).
Interventions: None.
Measurements and Main Results: We included 142 critically ill patients. The median age was 19 months (range, 2?110 months) with 39% of the patients <24 months of age. Ninety-nine patients (70%) had an underlying disease. Influenza A (pH1N1) 2009 infection was confirmed in 90 patients and the remaining 52 had a positive direct immunofluorescence assay for influenza A. The median length of stay in the pediatric intensive care unit was 12 days (range, 2?52 days). One hundred eighteen patients (83%) received invasive mechanical ventilation and 19 patients were treated with noninvasive ventilation; however, seven of the patients receiving noninvasive ventilation later needed mechanical ventilation. Sixty-eight patients died (47%) with the most frequent cause refractory hypoxemia. Multivariate logistic regression analysis showed that age <24 months (odds ratio, 2.87; 2.35?3.93), asthma (odds ratio, 1.34; 1.20?2.91), and respiratory coinfection with respiratory syncytial virus (odds ratio, 2.92; 1.20?4.10) were associated with higher mortality. As expected, mechanical ventilation and treatment with inotropes were also associated with increased mortality.
Conclusions: The mortality of children admitted to the pediatric intensive care unit with 2009 pH1N1 influenza was high (47%) in our population. Age <24 months, asthma, respiratory coinfection, need of mechanical ventilation, and treatment with inotropes were predictors of poorer outcome.
