Preparing your intensive care unit for the second wave of H1N1 and future surges

Hota, Susy; Fried, Elchanan; Burry, Lisa; Stewart, Thomas E.; Christian, Michael D.

doi:10.1097/ccm.0b013e3181c66940

Cited by 37 publications

(34 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Because influenza viruses rarely infect very young infants, pandemic planning has focused on adults and older children [13,17,23]. Since few reports are available on pandemic H1N1 influenza infection in infants, the objective of this study was to examine the clinical characteristics and management of the disease in very young infants.…”

Section: Introductionmentioning

confidence: 99%

Swine influenza A (H1N1) virus infection in infants

Zencıroğlu¹,

Kundak²,

Aydın³

et al. 2010

Eur J Pediatr

View full text Add to dashboard Cite

There are few reports on pandemic swine influenza A (H1N1) virus infection in very young infants. We aimed to discuss the clinical characteristics and management of the H1N1 influenza infection in very young infants. Clinical characteristics of ten infants diagnosed with H1N1 influenza virus infection during the 2009 outbreak season in a tertiary neonatal intensive care unit were evaluated. The diagnosis was confirmed by testing of respiratory samples with pandemic H1N1 influenza specific real-time PCR assay. Of the 46 patients with fever or respiratory problems, ten (22%) were diagnosed with H1N1 influenza virus infection during the 2009 (October-December) peak outbreak season. All infants including the preterms were admitted from home, seven (70%) were full-term and three (30%) were preterm. Median age of the patients at admission was 24.5 days. Fever and cough were the most common symptoms. Apnea was the initial symptoms in three patients. Two patients required oxygen support, one of which, a preterm baby, had been mechanically ventilated for 2 days. Mean duration of hospitalization was 7.8 ± 4.9 days. Chest radiography revealed radio-opacities on both lung fields in six patients. In addition, two patients had co-infection. All patients with proven infection were given oseltamivir medication. Recovery was achieved in all patients with no residual deficits or side effects from the antiviral oseltamivir treatment. The H1N1 influenza virus infection in very young infants appears to be mild to moderate in severity. The outcomes of the infants may be influenced by antiviral therapy. Treatment with antiviral oseltamivir appears to have no major adverse effects.

show abstract

Section: Introductionmentioning

confidence: 99%

Swine influenza A (H1N1) virus infection in infants

Zencıroğlu¹,

Kundak²,

Aydın³

et al. 2010

Eur J Pediatr

View full text Add to dashboard Cite

show abstract

“…16 Similarly, intensive care admissions in Australia and New Zealand were 28.7 cases per million population (15 times the normal admission rate for viral pneumonitis) in winter (June-August) 2009. 17 First-wave hospitalisations in Ontario, Canada, resulted in a 25% intensive care admission rate, 18 as did the first 272 hospitalisations in the USA, with the USA also reporting a 7% mortality rate. 19 However, the second pandemic wave in Mexico in June-July 2009 demonstrated much lower severity and mortality rates, possibly due to earlier antiviral treatment coincident with a nationwide publicity campaign.…”

Section: Chaptermentioning

confidence: 99%

Evaluation of triage methods used to select patients with suspected pandemic influenza for hospital admission: cohort study

Goodacre

Challen²,

Wilson³

et al. 2010

Health Technol Assess

View full text Add to dashboard Cite

*Corresponding authorthree survivors who required respiratory support. The five patients with poor outcomes had CURB-65 scores of zero, one (three cases) and two, and PMEWS scores of one, five, six, seven and eight. The swine flu hospital pathway was positive in three out of five cases. The C-statistic for each method was CURB-65 0.78 [95% confidence interval (CI) 0.58 to 0.99], PMEWS 0.77 (95% CI 0.55 to 0.99) and the swine flu hospital pathway 0.70 (95% CI 0.45 to 0.96). Patients with a higher CURB-65 score were more likely to be admitted (p < 0.001): 25 out of 101 (25%) with a score of zero, 11 out of 24 (46%) with a score of one, 7 out of 8 (88%) with a score of two, and the patient with a score of three were admitted. Admitted patients had a higher mean PMEWS score (4.6 vs 2.0, p < 0.001). The C-statistics for CURB-65, PMEWS and the swine flu hospital pathway in adults in terms of discriminating between those admitted and discharged were 0.65 (95% CI 0.54 to 0.76), 0.76 (95% CI 0.66 to 0.86) and 0.62 (95% CI 0.51 to 0.72) respectively. Limitations: The 2009 H1N1 pandemic was much smaller and less severe than predicted and resulted in a lack of sufficient data.

show abstract

“…Th e example of our facility illustrates that fl u pandemics may put tremendous pressure on supra-regional referral centres for extracorporeal therapy in terms of beds, medical equipment, personal resources, and costs, respectively. Our experience underlines the demand for institutional response plans and superordinate coordination of ICU capacities in case of disaster [24].…”

Section: Discussionmentioning

confidence: 99%

“…Die ECMO-Mortalität betrug 50 %. Die mediane ICU Liegedauer betrug 26 vs. 21 (17)(18)(19)(20)(21)(22)(23)(24)(25) (Überlebende vs. Nichtüberlebende), die Beatmungsdauer 18 vs. 20 (17)(18)(19)(20)(21)(22)(23)(24), und die ECMO Dauer 10 (8-25) vs. 13 (11)(12)(13)(14)(15)(16) Tage (p = n.s. ).…”

unclassified

A surge of flu-associated adult respiratory distress syndrome in an Austrian tertiary care hospital during the 2009/2010 Influenza A H1N1v pandemic

Schellongowski

Ullrich²,

Hieber³

et al. 2011

Wien Klin Wochenschr

View full text Add to dashboard Cite

We report on 17 patients with influenza A H1N1v-associated Adult Respiratory Distress Syndrome who were admitted to the intensive care unit (ICU) between June 11th 2009 and August 10th 2010 (f/m: 8/9; age: median 39 (IQR 29-54) years; SAPS II: 35 (29-48)). Body mass index was 26 (24-35), 24% were overweight and 29% obese. The Charlson Comorbidity Index was 1 (0-2) and all but one patient had comorbid conditions. The median time between onset of the first symptom and admission to the ICU was 5 days (range 0-14). None of the patients had received vaccination against H1N1v. Nine patients received oseltamivir, only two of them within 48 hours of symptom onset. All patients developed severe ARDS (PaO(2)/FiO(2)-Ratio 60 (55-92); lung injury score 3.8 (3.3-4.0)), were mechanically ventilated and on vasopressor support. Fourteen patients received corticosteroids, 7 patients underwent hemofiltration, and 10 patients needed extracorporeal membrane-oxygenation (ECMO; 8 patients veno-venous, 2 patients veno-arterial), three patients Interventional Lung Assist (ILA) and two patients pump driven extracorporeal low-flow CO(2)-elimination (ECCO(2)-R). Seven of 17 patients (41%) died in the ICU (4 patients due to bleeding, 3 patients due to multi-organ failure), while all other patients survived the hospital (59%). ECMO mortality was 50%. The median ICU length-of-stay was 26 (19-44) vs. 21 (17-25) days (survivors vs. nonsurvivors), days on the ventilator were 18 (14-35) vs. 20 (17-24), and ECMO duration was 10 (8-25) vs. 13 (11-16) days, respectively (all p = n.s.). Compared to a control group of 241 adult intensive care unit patients without H1N1v, length of stay in the ICU, rate of mechanical ventilation, days on the ventilator, and TISS 28 scores were significantly higher in patients with H1N1v. The ICU survival tended to be higher in control patients (79 vs. 59%; p = 0.06). Patients with H1N1v admitted to either of our ICUs were young, overproportionally obese and almost all with existing comorbidities. All patients developed severe ARDS, which could only be treated with extracorporeal gas exchange in an unexpectedly high proportion. Patients with H1N1v had more complicated courses compared to control patients.

show abstract

Preparing your intensive care unit for the second wave of H1N1 and future surges

Cited by 37 publications

References 35 publications

Swine influenza A (H1N1) virus infection in infants

Swine influenza A (H1N1) virus infection in infants

Evaluation of triage methods used to select patients with suspected pandemic influenza for hospital admission: cohort study

A surge of flu-associated adult respiratory distress syndrome in an Austrian tertiary care hospital during the 2009/2010 Influenza A H1N1v pandemic

Contact Info

Product

Resources

About