tetano
Editor, Senior Moderator
Crit Care Med. 2011 Jan 21. [Epub ahead of print]
Severe 2009 H1N1 influenza in pregnant women in Spain.
Marav?-Poma E, Martin-Loeches I, Regidor E, Laplaza C, Cambra K, Aldunate S, Guerrero JE, Loza-Vazquez A, Arnau E, Almirall J, Lorente L, Arenzana A, Magret M, Reig Valero R, Marquez E, Gonzalez N, Bermejo-Martin JF, Rello J; Grupo Espa?ol de Trabajo de Gripe Grave A (SEMICYUC).
From the Intensive Care Unit (EMP, CL, SA), Hospital Virgen del Camino, Pamplona; Critical Care Department (IML), Joan XXIII University Hospital, University Rovira i Virgili, CIBER Enfermedades Respiratorias (CIBERes) Tarragona; Unidad de Metodolog?a (KC), Fundaci?n Miguel Servet, Pamplona; Hospital Gregorio Mara??n (JEG), Madrid; Hospital Universitario de Valme (ALV), Sevilla; Hospital Universitario Vall d'Hebron (EA, JR), VHIR-UAB, CIBERES, Barcelona; Hospital de Matar? (JA), Matar?; CIBERES (LL), Barcelona Universitario de Canarias, Tenerife; Hospital Virgen de la Macarena (AA), Sevilla; Hospital Sant Joan de Reus (MM), Reus; Hospital General de Castell?n (RRV), Valencia; Hospital Infanta Elena (EM), Huelva; Hospital Donostia (NG), San Sebastian; and Infection and Immunity Unit (JFBM), Hospital Cl?nico Universitario-IECSCYL, Valladolid, Spain.
Abstract
OBJECTIVES: To describe the severity of the 2009 influenza H1N1v illness among pregnant women admitted to Spanish intensive care units.
DESIGN AND PATIENTS: Prospective, observational, multicenter study conducted in 148 Spanish intensive care units. We reviewed demographic and clinical data from the Spanish Society of Intensive Care Medicine database reported from April 23, 2009, to February 15, 2010. We included women of reproductive age (15-44 yrs) with confirmed H1N1v infection admitted to intensive care units.
MAIN RESULTS: Two hundred thirty-four women of reproductive age were admitted to intensive care units, 50 (21.4%) of them pregnant. Seven deaths were recorded in pregnant and 22 in nonpregnant women. Among intensive care unit admissions, there were no statistically significant differences between pregnant women and nonpregnant in Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment scores, chest x-rays, inotrope requirement, or need for mechanical ventilation or steroid therapy. Mortality risk was significantly associated with Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment, and obesity. Viral pneumonia was more frequent in pregnant women than in nonpregnant women, with an odds ratio (adjusted for asthma, time from onset influenza symptoms to hospital admission and obesity) of 4.9 (95% confidence interval: 1.4-17.2). The development of primary viral pneumonia in women of reproductive age appeared to be related to the time of commencement of antiviral treatment, the lowest rates being reported with initiation of antiviral therapy within 48 hrs of symptom onset (63.6% vs. 82.6%, p = .03). However, antiviral therapy was started within this time span in only 14% of pregnant women.
CONCLUSIONS: More than 20% of women of reproductive age admitted to intensive care unit for pH1N1 infection were pregnant. Pregnancy was significantly associated with primary viral pneumonia. Pregnant women should receive prompt treatment with oseltamivir within 48 hrs of the onset of influenza symptoms.
PMID: 21263317 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/21263317
Severe 2009 H1N1 influenza in pregnant women in Spain.
Marav?-Poma E, Martin-Loeches I, Regidor E, Laplaza C, Cambra K, Aldunate S, Guerrero JE, Loza-Vazquez A, Arnau E, Almirall J, Lorente L, Arenzana A, Magret M, Reig Valero R, Marquez E, Gonzalez N, Bermejo-Martin JF, Rello J; Grupo Espa?ol de Trabajo de Gripe Grave A (SEMICYUC).
From the Intensive Care Unit (EMP, CL, SA), Hospital Virgen del Camino, Pamplona; Critical Care Department (IML), Joan XXIII University Hospital, University Rovira i Virgili, CIBER Enfermedades Respiratorias (CIBERes) Tarragona; Unidad de Metodolog?a (KC), Fundaci?n Miguel Servet, Pamplona; Hospital Gregorio Mara??n (JEG), Madrid; Hospital Universitario de Valme (ALV), Sevilla; Hospital Universitario Vall d'Hebron (EA, JR), VHIR-UAB, CIBERES, Barcelona; Hospital de Matar? (JA), Matar?; CIBERES (LL), Barcelona Universitario de Canarias, Tenerife; Hospital Virgen de la Macarena (AA), Sevilla; Hospital Sant Joan de Reus (MM), Reus; Hospital General de Castell?n (RRV), Valencia; Hospital Infanta Elena (EM), Huelva; Hospital Donostia (NG), San Sebastian; and Infection and Immunity Unit (JFBM), Hospital Cl?nico Universitario-IECSCYL, Valladolid, Spain.
Abstract
OBJECTIVES: To describe the severity of the 2009 influenza H1N1v illness among pregnant women admitted to Spanish intensive care units.
DESIGN AND PATIENTS: Prospective, observational, multicenter study conducted in 148 Spanish intensive care units. We reviewed demographic and clinical data from the Spanish Society of Intensive Care Medicine database reported from April 23, 2009, to February 15, 2010. We included women of reproductive age (15-44 yrs) with confirmed H1N1v infection admitted to intensive care units.
MAIN RESULTS: Two hundred thirty-four women of reproductive age were admitted to intensive care units, 50 (21.4%) of them pregnant. Seven deaths were recorded in pregnant and 22 in nonpregnant women. Among intensive care unit admissions, there were no statistically significant differences between pregnant women and nonpregnant in Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment scores, chest x-rays, inotrope requirement, or need for mechanical ventilation or steroid therapy. Mortality risk was significantly associated with Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment, and obesity. Viral pneumonia was more frequent in pregnant women than in nonpregnant women, with an odds ratio (adjusted for asthma, time from onset influenza symptoms to hospital admission and obesity) of 4.9 (95% confidence interval: 1.4-17.2). The development of primary viral pneumonia in women of reproductive age appeared to be related to the time of commencement of antiviral treatment, the lowest rates being reported with initiation of antiviral therapy within 48 hrs of symptom onset (63.6% vs. 82.6%, p = .03). However, antiviral therapy was started within this time span in only 14% of pregnant women.
CONCLUSIONS: More than 20% of women of reproductive age admitted to intensive care unit for pH1N1 infection were pregnant. Pregnancy was significantly associated with primary viral pneumonia. Pregnant women should receive prompt treatment with oseltamivir within 48 hrs of the onset of influenza symptoms.
PMID: 21263317 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/21263317