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| |  Oseltamivir Plus Corticosteroids Improves Outcomes in Patients With Acute Respiratory Distress Syndrome, H1N1: Presented at CHEST 2009 By Betty S. Riggs SAN DIEGO -- November 9, 2009 -- The combination of oseltamivir and prolonged corticosteroid therapy results in clinical improvement in patients with hypoxaemic respiratory failure and influenza A(H1N1), according to a study presented here at CHEST 2009, the annual meeting of the American College of Chest Physicians. Gianfranco Umberto Meduri, MD, Memphis Veterans Affairs Medical Center, Memphis, Tennessee, presented the findings here on November 4. The study was a case control series reported from the intensive care unit (ICU) of a tertiary care hospital in Buenos Aires, Argentina, involving 13 patients with suspected H1N1, abnormal chest radiograph, and severe hypoxaemic respiratory failure requiring invasive mechanical ventilation. A pre-established comprehensive management protocol was followed that included high dose oseltamivir 150 mg bid for 5 days via nasogastric tube followed by 75 mg BID for 3 to 5 days based on clinical evolution. Corticosteroid treatment was initiated at ICU admission. Methylprednisolone 1 mg/kg/day for 14 days was used for those with severe acute respiratory distress syndrome, and hydrocortisone 300 mg/day was given to all other patients until discharge from the intensive care unit. Corticosteroid treatment was tapered prior to discontinuation. H1N1 was confirmed with nasopharyngeal swab specimens with real-time reverse-transcriptase polymerase-chain-reaction assay. From June 24 to July 12, 2009, 13 patients were admitted with suspected H1N1, pneumonia, and hypoxaemic respiratory failure. Of these, 8 had confirmed H1N1. By day 7 of treatment, patients had significant improvement in lung injury score (LIS) and multiple organ dysfunction syndrome as measured by the Sequential Organ Failure Assessment (SOFA) score. From day 1 to day 7, the LIS decreased from 2.83 +- 0.8 to 2.01 +- 0.5 (P = .003) in H1N1-positive patients and from 3.45 +- 0.3 to 2.15 +- 0.8 (P = .02) in H1N1-negative patients. From day 1 to day 7, the SOFA score decreased from 5.9 +- 1.6 to 3.3 +- 2.0 (P = .01) in H1N1-positive patients and from 7.4 +- 4.1 to 3.0 +- 3.5 (P = .01) in H1N1-negative patients. There was 1 death in the H1N1-positive patients (12.5%) thought to be due to pulmonary embolism and 1 death in the H1N1-negative group (20%) due to progression of multiple organ dysfunction syndrome. Major limitations of the study were the small sample size and lack of controls who were not treated with corticosteroid therapy. However, the study demonstrated that prolonged corticosteroid treatment is safe and is associated with significant improvement in lung injury score and multiple organ dysfunction syndrome in these patients. [Presentation title: H1N1 Influenza: A Virus-Associated Acute Respiratory Distress Syndrome: Response to Combination Oseltamivir and Prolonged Corticosteroid Treatment]
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