Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)v in Spain1Critical 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
Critical Care 2009, 13:R148doi:10.1186/cc8044
See related commentary by Opal, http://ccforum.com/content/13/5/196 AbstractIntroductionPatients 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. MethodsWe 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. ResultsIllness 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). ConclusionsOver 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. |



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