Research
Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)v in Spain
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* Corresponding author: Jordi Rello jrello.hj23.ics@gencat.cat
1 Critical Care Department, Joan XXIII University Hospital, CIBERes Enfermedades Respiratorias. IISPV. Mallafre Guasch 4 (43007)Tarragona, Spain
2 Critical Care Department, Son Llatzer Hospital, Crta. Manacor Km 4, (07198) Palma de Mallorca, Spain
3 La Fe Hospital, CIBERES, Av. Campanar 21 (46009) Valencia, Spain
4 De la Ribera Hospital. Crta. de Corbera Km 1 (46600) Alzira, Valencia, Spain
5 Gregorio Marañón Hospital, CIBERES, Calle Doctor Esquerdo 46 (28004) Madrid, Spain
6 Dr. Negrín Hospital, Barranco de la Ballena s/n (35010) Las Palmas de Gran Canarias, Spain
7 Infanta Elena, C/Red Corp, J. Andalucía s/n, (21700) Huelva, Spain
8 Severo Ochoa Hospital, Avd. de Orellana s/n (28911) Leganés, Madrid, Spain
9 Del Mar Hospital, CIBERES, Passeig Maritim 25-29 (08003) Barcelona, Spain
10 Insular Hospital de Gran Canarias, Carretera del Sur s/n (35016) Las Palmas de Gran Canarias, Spain
11 Clinic Hospital, IDIBAPS, CIBERES Enfermedades Respiratorias, C/Villarroel 170 (08036) Barcelona, Spain
12 San Jorge General Hospital, Av. Martínez de Velazco 36 (22004) Huesca, Spain
13 Bellvitge University Hospital, CIBERES, Feixa Llarga s/n (08907) Barcelona, Spain
14 Virgen del Camino Hospital, C/de Irunlarrea 4 (31008) Navarra, Spain
15 Hospital del Sureste, Ronda del Sur 10 (28500) Arganda del Rey, Madrid, Spain
16 Puerta del Mar Hospital, Avda Ana de Viya 21 (11009) Cádiz, Spain
17 Hospital Donostia, Paseo Dr. José Beguiristain s/n (20014) Donostia, San Sebastian, Spain
18 Josep Trueta University Hospital, Avda. França s/n (17007) Girona, Spain
19 Ramón y Cajal University Hospital, Ctra. De Colmenar Viejo Km 9,100 (28034) Madrid, Spain
20 La Paz University Hospital, P de la Castellana 261 (28046) Madrid, Spain
21 Hospital Nuestra Señora de Valme, Ctra. Cádiz-Bellavist Km 548 (41014) Sevilla, Spain
Critical Care 2009, 13:R148 doi:10.1186/cc8044
Published: 11 September 2009Abstract
Introduction
Patients with influenza A (H1N1)v infection have developed rapidly progressive lower respiratory tract disease resulting in respiratory failure. We describe the clinical and epidemiologic characteristics of the first 32 persons reported to be admitted to the intensive care unit (ICU) due to influenza A (H1N1)v infection in Spain.
Methods
We used medical chart reviews to collect data on ICU adult patients reported in a standardized form. Influenza A (H1N1)v infection was confirmed in specimens using real-time reverse transcriptase-polymerase-chain-reaction (RT PCR) assay.
Results
Illness onset of the 32 patients occurred between 23 June and 31 July, 2009. The median age was 36 years (IQR = 31 - 52). Ten (31.2%) were obese, 2 (6.3%) pregnant and 16 (50%) had pre-existing medical complications. Twenty-nine (90.6%) had primary viral pneumonitis, 2 (6.3%) exacerbation of structural respiratory disease and 1 (3.1%) secondary bacterial pneumonia. Twenty-four patients (75.0%) developed multiorgan dysfunction, 7 (21.9%) received renal replacement techniques and 24 (75.0%) required mechanical ventilation. Six patients died within 28 days, with two additional late deaths. Oseltamivir administration delay ranged from 2 to 8 days after illness onset, 31.2% received high-dose (300 mg/day), and treatment duration ranged from 5 to 10 days (mean 8.0 ± 3.3).
Conclusions
Over a 5-week period, influenza A (H1N1)v infection led to ICU admission in 32 adult patients, with frequently observed severe hypoxemia and a relatively high case-fatality rate. Clinicians should be aware of pulmonary complications of influenza A (H1N1)v infection, particularly in pregnant and young obese but previously healthy persons.