tetano
Editor, Senior Moderator
Indian J Crit Care Med. 2015 Nov;19(11):636-41. doi: 10.4103/0972-5229.169328.
[h=1]Critical illness associated with 2013-2014 influenza A (H1N1): Postpandemic characteristics, presentation and outcomes.[/h] Wiesen J[SUP]1[/SUP], Joshi D[SUP]1[/SUP], Guzman JA[SUP]1[/SUP], Duggal A[SUP]1[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]INTRODUCTION:[/h] The United States experienced a postpandemic outbreak of H1N1 influenza in 2013-2014. Unlike the pandemic in 2009 clinical course and outcomes associated with critical illness in this postpandemic outbreak has been only sparsely described.
[h=4]METHODS:[/h] We conducted a retrospective analysis of all patients admitted to the Medical Intensive Care Unit with H1N1 influenza infection in 2009-2010 (pandemic) and 2013-2014 (postpandemic).
[h=4]RESULTS:[/h] Patients admitted in the postpandemic period were older (55 ? 13 vs. 45 ? 12, P = 0.002), and had a higher incidence of underlying pulmonary (17 vs. 7, P = 0.0007) and cardiac (16 vs. 8, P = 0.005) disease. Mechanical ventilation was initiated in most patients in both groups (27 vs. 21, P = 1.00). The PaO2/FiO2 ratio was significantly higher in the pandemic group on days 1 (216 vs. 81, P = 0.0009), 3 (202 ? 99 vs. 100 ? 46, P = 0.002) and 7 (199 ? 103 vs. 113 ? 44, P = 0.019) but by day 14 no difference was seen between the groups. Rescue therapies were used in more patients in the postpandemic period (48% vs. 20%, P = 0.028), including more frequent use of prone ventilation (10 vs. 3, P = 0.015), inhaled vasodilator therapy (11 vs. 4, P = 0.015) and extracorporeal membrane oxygenation (ECMO) (4 vs. 2, P = NS). No significant differences in mortality were seen between the two cohorts.
[h=4]CONCLUSIONS:[/h] Compared to the 2009-2010 pandemic, the 2013-2014 H1N1 strain affected older patients with more underlying co-morbid cardio-pulmonary diseases. The patients had worse oxygenation indices and rescue modalities such as prone ventilation, inhaled epoprostenol and ECMO, were used more consistently as compared to the 2009 pandemic.
[h=4]KEYWORDS:[/h] Acute respiratory distress syndrome; influenza A; mechanical ventilation
PMID: 26730113 [PubMed] PMCID: PMC4687171 Free PMC Article
[h=1]Critical illness associated with 2013-2014 influenza A (H1N1): Postpandemic characteristics, presentation and outcomes.[/h] Wiesen J[SUP]1[/SUP], Joshi D[SUP]1[/SUP], Guzman JA[SUP]1[/SUP], Duggal A[SUP]1[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]INTRODUCTION:[/h] The United States experienced a postpandemic outbreak of H1N1 influenza in 2013-2014. Unlike the pandemic in 2009 clinical course and outcomes associated with critical illness in this postpandemic outbreak has been only sparsely described.
[h=4]METHODS:[/h] We conducted a retrospective analysis of all patients admitted to the Medical Intensive Care Unit with H1N1 influenza infection in 2009-2010 (pandemic) and 2013-2014 (postpandemic).
[h=4]RESULTS:[/h] Patients admitted in the postpandemic period were older (55 ? 13 vs. 45 ? 12, P = 0.002), and had a higher incidence of underlying pulmonary (17 vs. 7, P = 0.0007) and cardiac (16 vs. 8, P = 0.005) disease. Mechanical ventilation was initiated in most patients in both groups (27 vs. 21, P = 1.00). The PaO2/FiO2 ratio was significantly higher in the pandemic group on days 1 (216 vs. 81, P = 0.0009), 3 (202 ? 99 vs. 100 ? 46, P = 0.002) and 7 (199 ? 103 vs. 113 ? 44, P = 0.019) but by day 14 no difference was seen between the groups. Rescue therapies were used in more patients in the postpandemic period (48% vs. 20%, P = 0.028), including more frequent use of prone ventilation (10 vs. 3, P = 0.015), inhaled vasodilator therapy (11 vs. 4, P = 0.015) and extracorporeal membrane oxygenation (ECMO) (4 vs. 2, P = NS). No significant differences in mortality were seen between the two cohorts.
[h=4]CONCLUSIONS:[/h] Compared to the 2009-2010 pandemic, the 2013-2014 H1N1 strain affected older patients with more underlying co-morbid cardio-pulmonary diseases. The patients had worse oxygenation indices and rescue modalities such as prone ventilation, inhaled epoprostenol and ECMO, were used more consistently as compared to the 2009 pandemic.
[h=4]KEYWORDS:[/h] Acute respiratory distress syndrome; influenza A; mechanical ventilation
PMID: 26730113 [PubMed] PMCID: PMC4687171 Free PMC Article