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| |  Influenza A(H1N1) Critical Illness Can Occur Rapidly; Predominantly in Young Patients CHICAGO -- October 12, 2009 -- Critical illness among Canadian patients with influenza A(H1N1) occurred rapidly after hospital admission, often in young adults, and was associated with severely low levels of oxygen in the blood, multi-system organ failure, a need for prolonged mechanical ventilation, and frequent use of rescue therapies, according to a study to appear in the November 4 issue of JAMA. The study is being published early online to coincide with its presentation at a meeting of the European Society of Intensive Care Medicine. Infection with the H1N1 virus has been reported in virtually every country in the world. The World Health Organization declared the first phase 6 global influenza pandemic of the century onJune 11, 2009. The largest number of confirmed cases occurred in North America between March and July 2009, according to background information in the article. Anand Kumar, MD, Health Sciences Centre and St. Boniface Hospital, Winnipeg, Manitoba, and colleagues with the Canadian Critical Care Trials Group H1N1 Collaborative conducted an observational study of critically ill patients with influenza H1N1 in 38 adult and paediatric intensive care units (ICU) in Canada between April 16 and August 12, 2009. The study focused on the death rate at 28 and 90 days, as well as the frequency and duration of mechanical ventilation and the duration of ICU stay. The researchers found that a total of 168 patients had confirmed or probable H1N1 infection and became critically ill during this time period, and 24 (14.3%) died within the first 28 days from the onset of critical illness. Five more patients died within 90 days. The average age of the patients with confirmed or probable influenza H1N1 was 32.3 years, 113 were female (67.3%), and 50 were children (29.8%). “Our data suggest that severe disease and mortality in the current outbreak is concentrated in relatively healthy adolescents and adults between the ages of 10 and 60 years, a pattern reminiscent of the W-shaped curve previously seen only during the 1918 H1N1 Spanish pandemic,” the authors wrote. Patients with influenza H1N1 infection-related critical illness experienced symptoms for a median of 4 days before entering the hospital, but worsened rapidly and required care in the ICU within 1 or 2 days. Shock and multi-system organ failure were common, and 136 patients (81%) received mechanical ventilation, with the median duration being 12 days. The average ICU stay was 12 days. Lung rescue therapies included neuromuscular blockade, inhaled nitric oxide and high-frequency oscillatory ventilation. “In conclusion, we have demonstrated that influenza H1N1 infection-related critical illness predominantly affects young patients with few major comorbidities and is associated with severe hypoxemic respiratory failure, often requiring prolonged mechanical ventilation and rescue therapies,” the authors wrote. “With such therapy, we found that most patients can be supported through their critical illness.”
SOURCE: JAMA
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