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VOLUME 14 , ISSUE 2 ( April, 2010 ) > List of Articles

RESEARCH ARTICLE

Critically ill patients with 2009 H1N1 infection in an Indian ICU

B. Gagan, E. Ashok, M. Radha, H.V. Hemanth

Keywords : H1N1, influenza, virus, intensive care

Citation Information : Gagan B, Ashok E, Radha M, Hemanth H. Critically ill patients with 2009 H1N1 infection in an Indian ICU. Indian J Crit Care Med 2010; 14 (2):77-82.

DOI: 10.4103/0972-5229.68220

License: CC BY-ND 3.0

Published Online: 01-06-2017

Copyright Statement:  Copyright © 2010; The Author(s).


Abstract

Background and Aims: The 2009 pandemic influenza A (H1N1) has taken its toll across most parts of India. We aimed to study its epidemiology, clinical characteristics and outcomes from an Indian multidisciplinary intensive care unit (ICU). Materials and Methods: All patients admitted to our ICU with a flu-like illness and who tested positive for the 2009 H1N1 by reverse -transcriptase polymerase- chain -reaction assay during a 3 month period were prospectively studied. Results: Thirty one patients were admitted to the ICU during the study period. Patients were in the younger age group with a median age of 35 years (IQR: 28.2-42.8). Obesity was the commonest risk factor. Twenty six patients (83.9%) required ventilator support; the median duration of ventilator support was 10 days (IQR: 4-22). Severe hypoxemia was the predominant feature in all patients. Circulatory failure requiring vasopressors occurred in 18 (58.1%) patients and acute kidney injury in 6 (3.2%) patients. Twenty six patients were alive at the end of 28 days; subsequently all except one were discharged. The median duration of hospital stay was 15 (IQR: 8-22.5) days. Increasing APACHE II scores were associated with an increased risk of death (Hazard Ratio: 1.1; CI: 1.08 -1.2; P = 0.04). Mean tidal volumes in non-survivors were significantly lower; this was related to poor lung compliance in this group. Conclusions: 2009 H1N1 infection caused severe disease in relatively young patients without significant co-morbidities, characterized by severe hypoxemia and the requirement for prolonged mechanical ventilation. Extra-pulmonary organ failure included circulatory and renal failure.


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  1. Centers for Disease Control and Prevention (CDC). Swine influenza A (H1N1) infection in two children - Southern California, March-April 2009. MMWR Morb Mortal Wkly Rep 2009;58:400-2.
  2. World Health Organisation (Internet). Pandemic (H1N1) 2009 - update 75. (Updated 2009 November 20; cited 2009 November 20). Available from: http://www.who.int/csr/don/2009 22 20a/en/index.html
  3. World Health Organisation (Internet). Influenza A (H1N1): pandemic alert phase 6 declared, of moderate severity. (cited 2009 November 20). Available from: http://www.euro.who.int/influenza/AH1N1/20090611_11
  4. Ministry of Health and Family Welfare, Government of India (Internet). Pandemic Influenza A (H1N1). (Updated 2009 November 19; cited 2009 November 20). Available from: http://india.gov.in/outerwin.php?id=http://mohfw-h1n1.nic.in/
  5. World Health Organization (Internet).CDC protocol of realtime RT-PCR for influenza A (H1N1). (Updated 2009 October 6, cited 2009 November 21). Available from: http://www.who.int.csr/resources/publications/swineflu/realtimepcr/en/index.html
  6. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute Dialysis Quality Initiative workgroup. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8:R204-12.
  7. Ministry of Health and Family Welfare, Government of India (Internet). Pandemic Influenza-A (H1N1). (Cited 2009 November 21). Available from: http://mohfw-h1n1.nic.in/Epidemiological.html
  8. ANZIC Influenza Investigators, Webb SA, Pettilδ V, Seppelt I, Bellomo R, Bailey M, et al. Critical care services and 2009 H1N1 influenza in Australia and New Zealand. N Engl J Med 2009;361:1925-34.
  9. Kumar A, Zarychanski R, Pinto R, Cook DJ, Marshall J, Lacroix J, et al. Critically Ill Patients With 2009 Influenza A(H1N1) Infection in Canada. JAMA 2009;302:1872-9
  10. Jain S, Kamimoto L, Bramley AM, Schmitz AM, Benoit SR, Louie J, et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. N Engl J Med 2009;361:1935-44.
  11. Rello J, Rodrνguez A, Ibaρez P, Socias L, Cebrian J, Marques A, et al. Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)v in Spain. Crit Care 2009;13:R148.
  12. Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, Hernandez M, Quiρones-Falconi F, Bautista E, et al. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med 2009;361:680-9.
  13. Domνnguez-Cherit G, Lapinsky SE, Macias AE, Pinto R, Espinosa-Perez L, de la Torre A, et al. Critically Ill patients with 2009 influenza A(H1N1) in Mexico. JAMA 2009;302:1880-7.
  14. Thompson WW, Shay DK, Weintraub E, Brammer L, Bridges CB, Cox NJ, et al. Influenza associated hospitalizations in the United States. JAMA 2004;292:1333-40.
  15. Hancock K, Veguilla V, Lu X, Zhong W, Butler EN, Sun H, et al. Cross-reactive antibody responses to the 2009 pandemic H1N1 influenza virus. N Engl J Med 2009;361:1945-52.
  16. Bercault N, Boulain T, Kuteifan K, Wolf M, Runge I, Fleury JC. Obesity-related excess mortality rate in an adult intensive care unit: a risk-adjusted matched cohort study. Crit Care Med 2004;32:998-1003.
  17. Akinnusi ME, Pineda LA, El Solh AA. Effect of obesity on intensive care morbidity and mortality: a meta analysis. Crit Care Med 2008;36:151-8.
  18. Yaegashi M, Jean R, Zuriqat M, Noack S, Homel P. Outcome of morbid obesity in the intensive care unit. J Intensive Care Med 2005;20:147-54.
  19. Aldawood A, Arabi Y, Dabbagh O. Association of obesity with increased mortality in the critically ill patient. Anaesth Intensive Care 2006;34:629-33.
  20. Hogue CW Jr, Stearns JD, Colantuoni E, Robinson KA, Stierer T, Mitter N, et al. The impact of obesity on outcomes after critical illness: a meta-analysis. Intensive Care Med 2009;35:1152-70.
  21. Jamieson DJ, Honein MA, Rasmussen SA, Williams JL, Swerdlow DL, Biggerstaff MS, et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet 2009;374:451-8.
  22. Centers for Disease Control and Prevention (CDC). Intensive-care patients with severe novel infuenza A (H1N1) virus infection-Michigan, 2009. MMWR Morb Mortal Wkly Rep 2009;58:749-52.
  23. Agarwal PP, Cinti S, Kazerooni EA. Chest radiographic and CT findings in novel swine-origin influenza A (H1N1) virus (S-OIV) infection. AJR Am J Roentgenol 2009;193:1-6.
  24. Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators, Davies A, Jones D, Bailey M, Beca J, Bellomo R, et al. Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome. JAMA 2009;302:1888-95.
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