tetano
Editor, Senior Moderator
Pediatr Crit Care Med. 2010 Mar 19. [Epub ahead of print]
Critical illness in children with influenza A/pH1N1 2009 infection in Canada.
Jouvet P, Hutchison J, Pinto R, Menon K, Rodin R, Choong K, Kesselman M, Veroukis S, Andr? Dugas M, Santschi M, Guerguerian AM, Withington D, Alsaati B, Joffe AR, Drews T, Skippen P, Rolland E, Kumar A, Fowler R; for the Canadian Critical Care Trials Group H1N1 Collaborative.
From the Department of Pediatrics (PJ), Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada; Department of Critical Care and Neuroscience and Mental Health Research Program (JH, A-MG), Hospital for Sick Children, Toronto, Ontario, Canada; Departments of Medicine and Critical Care Medicine (RP, RF), Sunnybrook Hospital, Toronto, Ontario, Canada; Department of Pediatrics (KM), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; Department of Pediatrics and Critical Care (KC), McMaster Children's Hospital, Hamilton, Ontario, Canada; Department of Pediatrics and Child Health (MK, SVM, TD), Winnipeg's Children's Hospital, Winnipeg, Manitoba, Canada; Department of Pediatrics (MAD), Centre M?re-Enfant du CHUQ, Qu?bec, Qu?bec, Canada; Department of Pediatrics (MS), Sherbrooke Hospital, University of Sherbrooke, Sherbrooke, Quebec, Canada; Public Health Agency of Canada (RR, ER), Ottawa, Ontario, Canada; Department of Pediatrics (DW), Montreal Children's Hospital, Montreal, Quebec, Canada; Department of ---- (BA), Kingston General Hospital, Kingston, Ontario, Canada; Department of Pediatrics (ARJ), Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada; Pediatric Intensive Care Unit (PS), BC Children's Hospital, Vancouver, British Columbia, Canada; and Health Sciences Centre and St. Boniface Hospital (AK), Winnipeg, Manitoba, Canada.
OBJECTIVE:: To describe characteristics, treatment, and outcomes of critically ill children with influenza A/pH1N1 infection in Canada. DESIGN:: An observational study of critically ill children with influenza A/pH1N1 infection in pediatric intensive care units (PICUs). SETTING:: Nine Canadian PICUs. PATIENTS:: A total of 57 patients admitted to PICUs between April 16, 2009 and August 15, 2009. INTERVENTIONS:: --------. MEASUREMENTS AND MAIN RESULTS:: Characteristics of critically ill children with influenza A/pH1N1 infection were recorded. Confirmed intensive care unit cases were compared with a national surveillance database containing all hospitalized pediatric patients with influenza A/pH1N1 infection. Risk factors were assessed with a Cox proportional hazard model. The PICU cohort and national surveillance data were compared, using chi-square tests. Fifty-seven children were admitted to the PICU for community-acquired influenza A/pH1N1 infection. One or more chronic comorbid illnesses were observed in 70.2% of patients, and 24.6% of patients were aboriginal. Mechanical ventilation was used in 68% of children, 20 children (35.1%) had acute lung injury on the first day of admission, and the median duration of ventilation was 6 days (range, 0-67 days). The PICU mortality rate was 7% (4 of 57 patients). When compared with nonintensive care unit hospitalized children, PICU children were more likely to have a chronic medical condition (relative risk, 1.73); aboriginal ethnicity was not a risk factor of intensive care unit admission. CONCLUSIONS:: During the first outbreak of influenza A/pH1N1 infection, when the population was na?ve to this novel virus, severe illness was common among children with underlying chronic conditions and aboriginal children. Influenza A/pH1N1-related critical illness in children was associated with severe hypoxemic respiratory failure and prolonged mechanical ventilation. However, this higher rate and severity of respiratory illness did not result in an increased mortality when compared with seasonal influenza.
PMID: 20308929 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/20308929
Critical illness in children with influenza A/pH1N1 2009 infection in Canada.
Jouvet P, Hutchison J, Pinto R, Menon K, Rodin R, Choong K, Kesselman M, Veroukis S, Andr? Dugas M, Santschi M, Guerguerian AM, Withington D, Alsaati B, Joffe AR, Drews T, Skippen P, Rolland E, Kumar A, Fowler R; for the Canadian Critical Care Trials Group H1N1 Collaborative.
From the Department of Pediatrics (PJ), Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada; Department of Critical Care and Neuroscience and Mental Health Research Program (JH, A-MG), Hospital for Sick Children, Toronto, Ontario, Canada; Departments of Medicine and Critical Care Medicine (RP, RF), Sunnybrook Hospital, Toronto, Ontario, Canada; Department of Pediatrics (KM), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; Department of Pediatrics and Critical Care (KC), McMaster Children's Hospital, Hamilton, Ontario, Canada; Department of Pediatrics and Child Health (MK, SVM, TD), Winnipeg's Children's Hospital, Winnipeg, Manitoba, Canada; Department of Pediatrics (MAD), Centre M?re-Enfant du CHUQ, Qu?bec, Qu?bec, Canada; Department of Pediatrics (MS), Sherbrooke Hospital, University of Sherbrooke, Sherbrooke, Quebec, Canada; Public Health Agency of Canada (RR, ER), Ottawa, Ontario, Canada; Department of Pediatrics (DW), Montreal Children's Hospital, Montreal, Quebec, Canada; Department of ---- (BA), Kingston General Hospital, Kingston, Ontario, Canada; Department of Pediatrics (ARJ), Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada; Pediatric Intensive Care Unit (PS), BC Children's Hospital, Vancouver, British Columbia, Canada; and Health Sciences Centre and St. Boniface Hospital (AK), Winnipeg, Manitoba, Canada.
OBJECTIVE:: To describe characteristics, treatment, and outcomes of critically ill children with influenza A/pH1N1 infection in Canada. DESIGN:: An observational study of critically ill children with influenza A/pH1N1 infection in pediatric intensive care units (PICUs). SETTING:: Nine Canadian PICUs. PATIENTS:: A total of 57 patients admitted to PICUs between April 16, 2009 and August 15, 2009. INTERVENTIONS:: --------. MEASUREMENTS AND MAIN RESULTS:: Characteristics of critically ill children with influenza A/pH1N1 infection were recorded. Confirmed intensive care unit cases were compared with a national surveillance database containing all hospitalized pediatric patients with influenza A/pH1N1 infection. Risk factors were assessed with a Cox proportional hazard model. The PICU cohort and national surveillance data were compared, using chi-square tests. Fifty-seven children were admitted to the PICU for community-acquired influenza A/pH1N1 infection. One or more chronic comorbid illnesses were observed in 70.2% of patients, and 24.6% of patients were aboriginal. Mechanical ventilation was used in 68% of children, 20 children (35.1%) had acute lung injury on the first day of admission, and the median duration of ventilation was 6 days (range, 0-67 days). The PICU mortality rate was 7% (4 of 57 patients). When compared with nonintensive care unit hospitalized children, PICU children were more likely to have a chronic medical condition (relative risk, 1.73); aboriginal ethnicity was not a risk factor of intensive care unit admission. CONCLUSIONS:: During the first outbreak of influenza A/pH1N1 infection, when the population was na?ve to this novel virus, severe illness was common among children with underlying chronic conditions and aboriginal children. Influenza A/pH1N1-related critical illness in children was associated with severe hypoxemic respiratory failure and prolonged mechanical ventilation. However, this higher rate and severity of respiratory illness did not result in an increased mortality when compared with seasonal influenza.
PMID: 20308929 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/20308929