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Wiesen J, Joshi D, Guzman JA, et al. Critical illness associated with 2013-2014 influenza A (H1N1): Postpandemic characteristics, presentation and outcomes. Indian J Crit Care Med. 2015;19(11):636-41doi: 10.4103/0972-5229.169328.
Wiesen, J., Joshi, D., Guzman, J. A., & Duggal, A. (2015). Critical illness associated with 2013-2014 influenza A (H1N1): Postpandemic characteristics, presentation and outcomes. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 19(11), 636-41. https://doi.org/10.4103/0972-5229.169328
Wiesen, Jonathan, et al. "Critical illness associated with 2013-2014 influenza A (H1N1): Postpandemic characteristics, presentation and outcomes." Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine vol. 19,11 (2015): 636-41. doi: https://doi.org/10.4103/0972-5229.169328
Wiesen J, Joshi D, Guzman JA, Duggal A. Critical illness associated with 2013-2014 influenza A (H1N1): Postpandemic characteristics, presentation and outcomes. Indian J Crit Care Med. 2015 Nov;19(11):636-41. doi: 10.4103/0972-5229.169328. PMID: 26730113; PMCID: PMC4687171.
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Indian J Crit Care Med. 2015 Nov;19(11):636-41. doi: 10.4103/0972-5229.169328.

Critical illness associated with 2013-2014 influenza A (H1N1): Postpandemic characteristics, presentation and outcomes.

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

Jonathan Wiesen, Dhruv Joshi, Jorge A Guzman, Abhijit Duggal

Affiliations

  1. Department of Pulmonary Critical Care, Cleveland Clinic, Respiratory Institute, Cleveland, Ohio, USA.

PMID: 26730113 PMCID: PMC4687171 DOI: 10.4103/0972-5229.169328

Abstract

INTRODUCTION: The United States experienced a postpandemic outbreak of H1N1 influenza in 2013-2014. Unlike the pandemic in 2009 clinical course and outcomes associated with critical illness in this postpandemic outbreak has been only sparsely described.

METHODS: We conducted a retrospective analysis of all patients admitted to the Medical Intensive Care Unit with H1N1 influenza infection in 2009-2010 (pandemic) and 2013-2014 (postpandemic).

RESULTS: Patients admitted in the postpandemic period were older (55 ± 13 vs. 45 ± 12, P = 0.002), and had a higher incidence of underlying pulmonary (17 vs. 7, P = 0.0007) and cardiac (16 vs. 8, P = 0.005) disease. Mechanical ventilation was initiated in most patients in both groups (27 vs. 21, P = 1.00). The PaO2/FiO2 ratio was significantly higher in the pandemic group on days 1 (216 vs. 81, P = 0.0009), 3 (202 ± 99 vs. 100 ± 46, P = 0.002) and 7 (199 ± 103 vs. 113 ± 44, P = 0.019) but by day 14 no difference was seen between the groups. Rescue therapies were used in more patients in the postpandemic period (48% vs. 20%, P = 0.028), including more frequent use of prone ventilation (10 vs. 3, P = 0.015), inhaled vasodilator therapy (11 vs. 4, P = 0.015) and extracorporeal membrane oxygenation (ECMO) (4 vs. 2, P = NS). No significant differences in mortality were seen between the two cohorts.

CONCLUSIONS: Compared to the 2009-2010 pandemic, the 2013-2014 H1N1 strain affected older patients with more underlying co-morbid cardio-pulmonary diseases. The patients had worse oxygenation indices and rescue modalities such as prone ventilation, inhaled epoprostenol and ECMO, were used more consistently as compared to the 2009 pandemic.

Keywords: Acute respiratory distress syndrome; influenza A; mechanical ventilation

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