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Chest. Long-term Outcomes of Pandemic 2009 Influenza A(H1N1)-Associated Severe ARDS
[Source: Chest, full text: (LINK). Abstract, edited.]
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Long-term Outcomes of Pandemic 2009 Influenza A(H1N1)-Associated Severe ARDSLong-term Outcomes of 2009 Influenza A(H1N1) ARDS
Charles-Edouard Luyt, MD, PhD; Alain Combes, MD, PhD; Marie-H?l?ne Becquemin, MD; Catherine Beigelman-Aubry, MD; St?phane Hatem, MD, PhD; Anne-Laure Brun, MD; Nizar Zraik, MD; Fabrice Carrat, MD, PhD; Philippe A. Grenier, MD; Jean-Christophe M. Richard, MD; Alain Mercat, MD; Laurent Brochard, MD; Christian Brun-Buisson, MD; Jean Chastre, MD
Funding/Support: This study was funded by a grant from the INSERM-Institut de Microbiologie et Maladies Infectieuses, France, and French Ministry of Health.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.
CHEST.September 2012;142(3):583-592. doi:10.1378/chest.11-2196
Abstract
Background:
No data on long-term outcomes of survivors of 2009 influenza A(H1N1) (A[H1N1])-associated ARDS are available. The objective of this study was to compare the 1-year outcomes of survivors of A(H1N1)-associated ARDS, according to use or no use of extracorporeal lung assist (ECLA), using its need as an ARDS severity surrogate.
Methods:
Survivors of ARDS (12 with ECLA use vs 25 without, corresponding to 75% and 54% of the eligible patients for each group, respectively) selected from the R?seau Europ?en de Ventilation Artificielle (REVA) registry had previously been healthy, with only pregnancy and/or moderate obesity (BMI ≤ 35 kg/m<SUP>2</SUP>) as known risk factors for A(H1N1) infection. Lung function and morphology, health-related quality of life (HRQoL), and psychologic impairment were evaluated.
Results:
At 1 year post-ICU discharge for the ECLA and no-ECLA groups, respectively, 50% and 40% reported significant exertion dyspnea, 83% and 64% had returned to work, and 75% and 64% had decreased diffusion capacity across the blood-gas barrier, despite their near-normal and similar lung function test results. For both groups, exercise test results showed diminished but comparable exercise capacities, with similar alveolar-arterial oxygen gradients at peak exercise, and CT scans showed minor abnormal findings. HRQoL assessed by the 36-Item Short-Form Health Survey was poorer for both groups than for a sex- and age-matched general population group, but without between-group differences. ECLA and no-ECLA group patients, respectively, had symptoms of anxiety (50% and 56%) and depression (28% and 28%) and were at risk for posttraumatic stress disorder (41% and 44%).
Conclusions:
One year post-ICU discharge, a majority of survivors of A(H1N1)-associated ARDS had minor lung disabilities with diminished diffusion capacities across the blood-gas barrier, and most had psychologic impairment and poorer HRQoL than a sex- and age-matched general population group. ECLA and no-ECLA group patients had comparable outcomes.
Trial registry: ClinicalTrials.gov; No.: NCT01271842; URL: www.clinicaltrials.gov
From the Service de R?animation M?dicale (Drs Luyt, Combes and Chastre), Service d?Explorations Fonctionnelles (Drs Becquemin and Zraik), Service de Radiologie (Drs Beigelman-Aubry, Brun, and Grenier), and Service d?explorations fonctionnelles cardio-vasculaires (Dr Hatem), Groupe Hospitalier Piti?-Salp?tri?re, Assistance Publique-H?pitaux de Paris et Universit? Paris 6-Pierre-et-Marie-Curie, Paris France; and Service de Sant? Publique, H?pital Saint-Antoine (Dr Carrat), Assistance Publique-H?pitaux de Paris, Unit? Mixte de Recherche-S 707, Institut National de la Sant? et de la Recherche M?dicale (INSERM), Universit? Paris 6-Pierre-et-Marie-Curie, Paris, France; Service de R?animation M?dicale (Dr Richard), Centre Hospitalier Universitaire de Rouen, Rouen; Service de R?animation M?dicale (Dr Mercat), Centre Hospitalier Universitaire d?Angers, Angers, France; Intensive Care Unit (Dr Brochard), H?pitaux Universitaires de Gen?ve, Gen?ve, Switzerland; and Service de R?animation M?dicale (Dr Brun-Buisson), H?pital Henri-Mondor, Assistance Publique-H?pitaux de Paris, Universit? Paris 12, Cr?teil, France.Correspondence to: Charles-Edouard Luyt, MD, PhD, Service de R?animation M?dicale, Institut de Cardiologie, Groupe Hospitalier Piti?-Salp?tri?re, 47, boulevard de l?H?pital, 75651 Paris Cedex 13, France; e-mail: charles-edouard.luyt@psl.aphp.fr
Author contributions: Dr Luyt is the guarantor of the manuscript.
Dr Luyt: contributed to study conception and design; acquisition, analysis, and interpretation of data; drafting of the article; and revising, reading, and approving the final version of the article.
Dr Combes: contributed to study conception and design; acquisition, analysis, and interpretation of data; drafting of the article; and revising, reading, and approving the final version of the article.
Dr Becquemin: contributed to acquisition, analysis, and interpretation of data and revising, reading, and approving the final version of the article.
Dr Beigelman-Aubry: contributed to acquisition, analysis, and interpretation of data and revising, reading, and approving the final version of the article.
Dr Hatem: contributed to acquisition, analysis, and interpretation of data and revising, reading, and approving the final version of the article.
Dr Brun: contributed to acquisition, analysis, and interpretation of data and revising, reading, and approving the final version of the article.
Dr Zraik: contributed to revising, reading, and approving the final version of the article.
Dr Carrat: contributed to study conception and design; analysis and interpretation of data; and revising, reading, and approving the final version of the article.
Dr Grenier: contributed to acquisition, analysis, and interpretation of data and revising, reading, and approving the final version of the article.
Dr Richard: contributed to study conception and design and revising, reading, and approving the final version of the article.
Dr Mercat: contributed to study conception and design and revising, reading, and approving the final version of the article.
Dr Brochard: contributed to study conception and design and revising, reading, and approving the final version of the article.
Dr Brun-Buisson: contributed to study conception and design and revising, reading, and approving the final version of the article.
Dr Chastre: contributed to study conception and design; drafting of the article; and revising, reading, and approving the final version of the article.
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Carrat reported having received fees for consultancies on influenza vaccine from GlaxoSmithKline and Novartis AG. Dr Mercat received research grants from General Electric Company and Covidien, in-kind benefits from Covidien, and fees for consultancy from Faron Pharmaceuticals, Ltd and is involved in a patent with General Electric Company. Drs Luyt, Combes, Becquemin, Beigelman-Aubry, Hatem, Brun, Zraik, Grenier, Richard, Brochard, Brun-Buisson, and Chastre have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Role of sponsors: No funding source had any role in the design or conduct of the study or in collection, management, analysis, interpretation of the data, or preparation of the manuscript.
Other contributions: We thank Jessica Palmyre and Benjamin Cohen for their outstanding technical assistance in conducting the trial; Bettina Begeneau and Zahia Roberge for their technical help; Samir Medjane, PhD, and Henda Cheikhrouhou for their contributions; and all the staff of the departments involved in patient care and evaluation.
Additional information: The e-Appendixes and e-Tables can be found in the ?Supplemental Materials? area of the online article.
For editorial comment see page 583Members of the REVA Study Group are listed in e-Appendix 1.
Funding/Support: This study was funded by a grant from the INSERM-Institut de Microbiologie et Maladies Infectieuses, France, and French Ministry of Health.Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.
-Charles-Edouard Luyt, MD, PhD; Alain Combes, MD, PhD; Marie-H?l?ne Becquemin, MD; Catherine Beigelman-Aubry, MD; St?phane Hatem, MD, PhD; Anne-Laure Brun, MD; Nizar Zraik, MD; Fabrice Carrat, MD, PhD; Philippe A. Grenier, MD; Jean-Christophe M. Richard, MD; Alain Mercat, MD; Laurent Brochard, MD; Christian Brun-Buisson, MD; Jean Chastre, MD
Funding/Support: This study was funded by a grant from the INSERM-Institut de Microbiologie et Maladies Infectieuses, France, and French Ministry of Health.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.
CHEST.September 2012;142(3):583-592. doi:10.1378/chest.11-2196
Abstract
Background:
No data on long-term outcomes of survivors of 2009 influenza A(H1N1) (A[H1N1])-associated ARDS are available. The objective of this study was to compare the 1-year outcomes of survivors of A(H1N1)-associated ARDS, according to use or no use of extracorporeal lung assist (ECLA), using its need as an ARDS severity surrogate.
Methods:
Survivors of ARDS (12 with ECLA use vs 25 without, corresponding to 75% and 54% of the eligible patients for each group, respectively) selected from the R?seau Europ?en de Ventilation Artificielle (REVA) registry had previously been healthy, with only pregnancy and/or moderate obesity (BMI ≤ 35 kg/m<SUP>2</SUP>) as known risk factors for A(H1N1) infection. Lung function and morphology, health-related quality of life (HRQoL), and psychologic impairment were evaluated.
Results:
At 1 year post-ICU discharge for the ECLA and no-ECLA groups, respectively, 50% and 40% reported significant exertion dyspnea, 83% and 64% had returned to work, and 75% and 64% had decreased diffusion capacity across the blood-gas barrier, despite their near-normal and similar lung function test results. For both groups, exercise test results showed diminished but comparable exercise capacities, with similar alveolar-arterial oxygen gradients at peak exercise, and CT scans showed minor abnormal findings. HRQoL assessed by the 36-Item Short-Form Health Survey was poorer for both groups than for a sex- and age-matched general population group, but without between-group differences. ECLA and no-ECLA group patients, respectively, had symptoms of anxiety (50% and 56%) and depression (28% and 28%) and were at risk for posttraumatic stress disorder (41% and 44%).
Conclusions:
One year post-ICU discharge, a majority of survivors of A(H1N1)-associated ARDS had minor lung disabilities with diminished diffusion capacities across the blood-gas barrier, and most had psychologic impairment and poorer HRQoL than a sex- and age-matched general population group. ECLA and no-ECLA group patients had comparable outcomes.
Trial registry: ClinicalTrials.gov; No.: NCT01271842; URL: www.clinicaltrials.gov
From the Service de R?animation M?dicale (Drs Luyt, Combes and Chastre), Service d?Explorations Fonctionnelles (Drs Becquemin and Zraik), Service de Radiologie (Drs Beigelman-Aubry, Brun, and Grenier), and Service d?explorations fonctionnelles cardio-vasculaires (Dr Hatem), Groupe Hospitalier Piti?-Salp?tri?re, Assistance Publique-H?pitaux de Paris et Universit? Paris 6-Pierre-et-Marie-Curie, Paris France; and Service de Sant? Publique, H?pital Saint-Antoine (Dr Carrat), Assistance Publique-H?pitaux de Paris, Unit? Mixte de Recherche-S 707, Institut National de la Sant? et de la Recherche M?dicale (INSERM), Universit? Paris 6-Pierre-et-Marie-Curie, Paris, France; Service de R?animation M?dicale (Dr Richard), Centre Hospitalier Universitaire de Rouen, Rouen; Service de R?animation M?dicale (Dr Mercat), Centre Hospitalier Universitaire d?Angers, Angers, France; Intensive Care Unit (Dr Brochard), H?pitaux Universitaires de Gen?ve, Gen?ve, Switzerland; and Service de R?animation M?dicale (Dr Brun-Buisson), H?pital Henri-Mondor, Assistance Publique-H?pitaux de Paris, Universit? Paris 12, Cr?teil, France.Correspondence to: Charles-Edouard Luyt, MD, PhD, Service de R?animation M?dicale, Institut de Cardiologie, Groupe Hospitalier Piti?-Salp?tri?re, 47, boulevard de l?H?pital, 75651 Paris Cedex 13, France; e-mail: charles-edouard.luyt@psl.aphp.fr
Author contributions: Dr Luyt is the guarantor of the manuscript.
Dr Luyt: contributed to study conception and design; acquisition, analysis, and interpretation of data; drafting of the article; and revising, reading, and approving the final version of the article.
Dr Combes: contributed to study conception and design; acquisition, analysis, and interpretation of data; drafting of the article; and revising, reading, and approving the final version of the article.
Dr Becquemin: contributed to acquisition, analysis, and interpretation of data and revising, reading, and approving the final version of the article.
Dr Beigelman-Aubry: contributed to acquisition, analysis, and interpretation of data and revising, reading, and approving the final version of the article.
Dr Hatem: contributed to acquisition, analysis, and interpretation of data and revising, reading, and approving the final version of the article.
Dr Brun: contributed to acquisition, analysis, and interpretation of data and revising, reading, and approving the final version of the article.
Dr Zraik: contributed to revising, reading, and approving the final version of the article.
Dr Carrat: contributed to study conception and design; analysis and interpretation of data; and revising, reading, and approving the final version of the article.
Dr Grenier: contributed to acquisition, analysis, and interpretation of data and revising, reading, and approving the final version of the article.
Dr Richard: contributed to study conception and design and revising, reading, and approving the final version of the article.
Dr Mercat: contributed to study conception and design and revising, reading, and approving the final version of the article.
Dr Brochard: contributed to study conception and design and revising, reading, and approving the final version of the article.
Dr Brun-Buisson: contributed to study conception and design and revising, reading, and approving the final version of the article.
Dr Chastre: contributed to study conception and design; drafting of the article; and revising, reading, and approving the final version of the article.
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Carrat reported having received fees for consultancies on influenza vaccine from GlaxoSmithKline and Novartis AG. Dr Mercat received research grants from General Electric Company and Covidien, in-kind benefits from Covidien, and fees for consultancy from Faron Pharmaceuticals, Ltd and is involved in a patent with General Electric Company. Drs Luyt, Combes, Becquemin, Beigelman-Aubry, Hatem, Brun, Zraik, Grenier, Richard, Brochard, Brun-Buisson, and Chastre have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Role of sponsors: No funding source had any role in the design or conduct of the study or in collection, management, analysis, interpretation of the data, or preparation of the manuscript.
Other contributions: We thank Jessica Palmyre and Benjamin Cohen for their outstanding technical assistance in conducting the trial; Bettina Begeneau and Zahia Roberge for their technical help; Samir Medjane, PhD, and Henda Cheikhrouhou for their contributions; and all the staff of the departments involved in patient care and evaluation.
Additional information: The e-Appendixes and e-Tables can be found in the ?Supplemental Materials? area of the online article.
For editorial comment see page 583Members of the REVA Study Group are listed in e-Appendix 1.
Funding/Support: This study was funded by a grant from the INSERM-Institut de Microbiologie et Maladies Infectieuses, France, and French Ministry of Health.Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.
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