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01.08.2011 | Research | Ausgabe 4/2011 Open Access

Critical Care 4/2011

Lung Function and Organ Dysfunctions in 178 Patients Requiring Mechanical Ventilation During The 2009 Influenza A (H1N1) Pandemic

Zeitschrift:
Critical Care > Ausgabe 4/2011
Autoren:
Fernando G Ríos, Elisa Estenssoro, Fernando Villarejo, Ricardo Valentini, Liliana Aguilar, Daniel Pezzola, Pascual Valdez, Miguel Blasco, Cristina Orlandi, Javier Alvarez, Fernando Saldarini, Alejandro Gómez, Pablo E Gómez, Martin Deheza, Alan Zazu, Mónica Quinteros, Ariel Chena, Javier Osatnik, Damian Violi, Maria Eugenia Gonzalez, Guillermo Chiappero
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​cc10369) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

FGR conceived and coordinated the study. FGR and EE drafted the manuscript and performed the statistical analysis. FGR, FV, RV, AG, DV and GC participated in the design of the study. FGR, EE, FV, RV, LA, DP, PV, MB, CO, JA, FS, AG, PEG, MD, AZ, MQ, AC, JO, DV, MEG, GC and the rest of the members of the Registry performed the acquisition of data. All authors read and approved the final manuscript.

Abstract

Introduction

Most cases of the 2009 influenza A (H1N1) infection are self-limited, but occasionally the disease evolves to a severe condition needing hospitalization. Here we describe the evolution of the respiratory compromise, ventilatory management and laboratory variables of patients with diffuse viral pneumonitis caused by pandemic 2009 influenza A (H1N1) admitted to the ICU.

Method

This was a multicenter, prospective inception cohort study including adult patients with acute respiratory failure requiring mechanical ventilation (MV) admitted to 20 ICUs in Argentina between June and September of 2009 during the influenza A (H1N1) pandemic. In a standard case-report form, we collected epidemiological characteristics, results of real-time reverse-transcriptase--polymerase-chain-reaction viral diagnostic tests, oxygenation variables, acid-base status, respiratory mechanics, ventilation management and laboratory tests. Variables were recorded on ICU admission and at days 3, 7 and 10.

Results

During the study period 178 patients with diffuse viral pneumonitis requiring MV were admitted. They were 44 ± 15 years of age, with Acute Physiology And Chronic Health Evaluation II (APACHE II) scores of 18 ± 7, and most frequent comorbidities were obesity (26%), previous respiratory disease (24%) and immunosuppression (16%). Non-invasive ventilation (NIV) was applied in 49 (28%) patients on admission, but 94% were later intubated.
Acute respiratory distress syndrome (ARDS) was present throughout the entire ICU stay in the whole group (mean PaO2/FIO2 170 ± 25). Tidal-volumes used were 7.8 to 8.1 ml/kg (ideal body weight), plateau pressures always remained < 30 cmH2O, without differences between survivors and non-survivors; and mean positive end-expiratory pressure (PEEP) levels used were between 8 to 12 cm H2O. Rescue therapies, like recruitment maneuvers (8 to 35%), prone positioning (12 to 24%) and tracheal gas insufflation (3%) were frequently applied. At all time points, pH, platelet count, lactate dehydrogenase assay (LDH) and Sequential Organ Failure Assessment (SOFA) differed significantly between survivors and non-survivors. Lack of recovery of platelet count and persistence of leukocytosis were characteristic of non-survivors. Mortality was high (46%); and length of MV was 10 (6 to 17) days.

Conclusions

These patients had severe, hypoxemic respiratory failure compatible with ARDS that persisted over time, frequently requiring rescue therapies to support oxygenation. NIV use is not warranted, given its high failure rate. Death and evolution to prolonged mechanical ventilation were common outcomes. Persistence of thrombocytopenia, acidosis and leukocytosis, and high LDH levels found in non-survivors during the course of the disease might be novel prognostic findings.
Zusatzmaterial
Authors’ original file for figure 1
13054_2011_9741_MOESM1_ESM.pdf
Authors’ original file for figure 2
13054_2011_9741_MOESM2_ESM.pdf
Authors’ original file for figure 3
13054_2011_9741_MOESM3_ESM.pdf
Authors’ original file for figure 4
13054_2011_9741_MOESM4_ESM.tiff
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