Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)v in Spain

doi:10.1186/cc8044

Critical Care
Volume 13
Issue 5

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Rello J
Rodríguez A
Ibañez P
Socias L
Cebrian J
Marques A
Guerrero J
Ruiz-Santana S
Marquez E
Del Nogal-Saez F
Alvarez-Lerma F
Martínez S
Ferrer M
Avellanas M
Granada R
Maraví-Poma E
Albert P
Sierra R
Vidaur L
Ortiz P
Prieto del Portillo I
Galván B
León-Gil C

on PubMed

Rello J
Rodríguez A
Ibañez P
Socias L
Cebrian J
Marques A
Guerrero J
Ruiz-Santana S
Marquez E
Del Nogal-Saez F
Alvarez-Lerma F
Martínez S
Ferrer M
Avellanas M
Granada R
Maraví-Poma E
Albert P
Sierra R
Vidaur L
Ortiz P
Prieto del Portillo I
Galván B
León-Gil C
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Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)v in Spain

Jordi Rello¹ , Alejandro Rodríguez¹ , Pedro Ibañez² , Lorenzo Socias² , Javier Cebrian³ , Asunción Marques⁴ , José Guerrero⁵ , Sergio Ruiz-Santana⁶ , Enrique Marquez⁷ , Frutos Del Nogal-Saez⁸ , Francisco Alvarez-Lerma⁹ , Sergio Martínez¹⁰ , Miquel Ferrer¹¹ , Manuel Avellanas¹² , Rosa Granada¹³ , Enrique Maraví-Poma¹⁴ , Patricia Albert¹⁵ , Rafael Sierra¹⁶ , Loreto Vidaur¹⁷ , Patricia Ortiz¹⁸ , Isidro Prieto del Portillo¹⁹ , Beatriz Galván²⁰ and Cristóbal León-Gil²¹ for the H1N1 SEMICYUC working group

¹Critical Care Department, Joan XXIII University Hospital, CIBERes Enfermedades Respiratorias. IISPV. Mallafre Guasch 4 (43007)Tarragona, Spain

²Critical Care Department, Son Llatzer Hospital, Crta. Manacor Km 4, (07198) Palma de Mallorca, Spain

³La Fe Hospital, CIBERES, Av. Campanar 21 (46009) Valencia, Spain

⁴De la Ribera Hospital. Crta. de Corbera Km 1 (46600) Alzira, Valencia, Spain

⁵Gregorio Marañón Hospital, CIBERES, Calle Doctor Esquerdo 46 (28004) Madrid, Spain

⁶Dr. Negrín Hospital, Barranco de la Ballena s/n (35010) Las Palmas de Gran Canarias, Spain

⁷Infanta Elena, C/Red Corp, J. Andalucía s/n, (21700) Huelva, Spain

⁸Severo Ochoa Hospital, Avd. de Orellana s/n (28911) Leganés, Madrid, Spain

⁹Del Mar Hospital, CIBERES, Passeig Maritim 25-29 (08003) Barcelona, Spain

¹⁰Insular Hospital de Gran Canarias, Carretera del Sur s/n (35016) Las Palmas de Gran Canarias, Spain

¹¹Clinic Hospital, IDIBAPS, CIBERES Enfermedades Respiratorias, C/Villarroel 170 (08036) Barcelona, Spain

¹²San Jorge General Hospital, Av. Martínez de Velazco 36 (22004) Huesca, Spain

¹³Bellvitge University Hospital, CIBERES, Feixa Llarga s/n (08907) Barcelona, Spain

¹⁴Virgen del Camino Hospital, C/de Irunlarrea 4 (31008) Navarra, Spain

¹⁵Hospital del Sureste, Ronda del Sur 10 (28500) Arganda del Rey, Madrid, Spain

¹⁶Puerta del Mar Hospital, Avda Ana de Viya 21 (11009) Cádiz, Spain

¹⁷Hospital Donostia, Paseo Dr. José Beguiristain s/n (20014) Donostia, San Sebastian, Spain

¹⁸Josep Trueta University Hospital, Avda. França s/n (17007) Girona, Spain

¹⁹Ramón y Cajal University Hospital, Ctra. De Colmenar Viejo Km 9,100 (28034) Madrid, Spain

²⁰La Paz University Hospital, P de la Castellana 261 (28046) Madrid, Spain

²¹Hospital Nuestra Señora de Valme, Ctra. Cádiz-Bellavist Km 548 (41014) Sevilla, Spain

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Critical Care 2009, 13:R148doi:10.1186/cc8044


Published:	11 September 2009

See related commentary by Opal, http://ccforum.com/content/13/5/196

Abstract

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.