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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

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

Keywords : H1N1, influenza, virus, intensive care

Citation Information : Chacko J, 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: 01-04-2010

Copyright Statement:  Copyright © 2010; Jaypee Brothers Medical Publishers (P) Ltd.


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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