High success and low mortality rates with non-invasive ventilation in influenza A H1N1 patients in a tertiary hospital

BMC Research Notes

Oscar FP dos Santos¹  Raquel AC Eid¹  Alexandre R Marra¹  Luci Correa¹  Claudia V Silvia¹  Corinne Taniguchi¹  Cilene Saghabi¹  Silvia HCT Aquino¹  Karina T Timenetsky¹ 

[1] Critically Ill Patients Department, Albert Einstein Jewish Hospital (Avenida Albert Einstein, 627), Sao Paulo (zip code 05652900), Brazil

关键词: respiratory illness;    mortality;    non-invasive ventilation;    influenza A H1N1;   

Others  :  1167143
DOI  :  10.1186/1756-0500-4-375

 received in 2011-06-15, accepted in 2011-09-28,  发布年份 2011

【 摘 要 】

Background

In 2009, an outbreak of respiratory illness caused by influenza A H1N1 virus occurred worldwide. Some patients required Intensive Care Unit (ICU) admission. The use of non-invasive ventilation (NIV) in these patients is controversial, as the aerosol dispersion may contaminate the environment and health-care co-workers.

Methods

Describe the respiratory profile, the mortality rate, and the benefit of using NIV in patients with confirmed diagnosis of influenza AH1N1 who were admitted in the ICU during the year 2009.

Results

A total of 1, 401 cases of influenza A H1N1 were confirmed in our hospital by real-time RT-PCR in 2009, and 20 patients were admitted to the ICU. The patients' ages ranged from 18 to 74 years (median of 42). Acute Respiratory Failure (ARF) was present in 70% of patients. The median Acute Physiology and Chronic Health Evaluation II score was 7 (range 7 to 25). Of the 14 patients who developed ARF, 85.7% needed NIV and 14% needed invasive MV at admission. Our success rate (41.6%) with NIV was higher than that described by others. The hospital mortality rate was 2.1%. When influenza A H1N1 arrived in Brazil, the disease was already on endemic alert in other countries. The population was already aware of the symptoms and the health-care system of the treatment. This allowed patients to be properly and promptly treated for influenza A H1N1, while health-care workers took protective measures to avoid contamination.

Conclusion

In our study we found a high success and low mortality rates with non-invasive ventilation in patients with influenza A H1N1.

【 授权许可】

   
2011 Timenetsky et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Perez-Padilla R, Rosa-Zamboni D, Leon SP, Hernandez M, Quinones-Falconi F, Bautista E, Ramirez-Venegas A, Rojas-Serrano J, Ormsby CE, Corrales A, Higuera A, Mondragon E, Cordova-Villalobos JA: Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med 2009, 361:680-9.
• [2]Rello J, Rodriguez A, Ibañes P, Sócias L, Cebrian J, Marques A, Guerrero J, Ruiz-Santana S, Marquez E, Nogal-Saez FD, Alvarez-Lema F, Martinez S, Ferrer M, Avellanas M, Granada R, Maraví-Poma E, Albert P, Sierra R, Vidaur L, Ortiz P, del Portillo IP, Galván B, León-Gil C: Intensive care adult patients with severe respiratory failure caused by influenza A (H1N1)v in Spain. [http://ccforum.com/content/13/5/R148] webcite
• [3]Jain S, Kamimoto L, Bramley AM, Schmitz AM, Benoit SR, Louie J, Sugerman DE, Druckenmiller JK, Ritger KA, Chugh R, Jasuja S, Deutscher M, Chen S, Walker JD, Duchin JS, Lett S, Soliva S, Wells EV, Swerdlow D, Uyeki TM, Fiore AE, Olsen SJ, Fry AM, Bridges CB, Finelli L: Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. N Engl J Med 2009, 361:1935-44.
• [4]Libster R, Bugna J, Coviello S, Hijano DR, Dunaiewsky M, Reynoso N, Cavalieri ML, Guglielmo MC, Areso MS, Gilligan T, Santucho F, Cabral G, Gregorio GL, Moreno R, Lutz MI, Panigasi AL, Saligari L, Caballero MT, Egües Almeida RM, Gutierrez Meyer ME, Neder MD, Davenport MC, Del Valle MP, Santidrian VS, Mosca G, Garcia Domínguez M, Alvarez L, Landa P, Pota A, , , , , , , , , , , , , , , , , , , , , et al.: Pediatric hospitalizations associated with 2009 pandemic influenza A (H1N1) in Argentina. In N Engl J Med. Volume 362. ; 2010::45-55.
• [5]Shimada T, Gu Y, Kamiya H, Komiya N, Odaira F, Sunagawa T, Takahashi H, Toyokawa T, Tsuchihashi Y, Yasui Y, Tada Y, Okabe N: Epidemiology of influenza A(H1N1)v virus infection in Japan, May-June 2009. Euro Surveill 2009, 14:pii19244.
• [6]Cao B, Li X-W, Mao Y, Wang J, Lu HZ, Chen YS, Liang ZA, Liang L, Zhang SJ, Zhang B, Gu L, Lu LH, Wang DY, Wang C: Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China. N Engl J Med 2009, 361:2507-17.
• [7]Hackett S, Hill L, Patel J, Ratnaraja N, Ifeyinwa A, Farrogi M, Nusgen U, Debenham P, Gandhi D, Makwana N, Smit E, Welch S: Clinical characteristics of paediatric H1N1 admissions in Birmingham, UK. Lancet 2009, 374:605.
• [8]Kumar A, Zarychanski R, Pinto R, Cook DJ, Marshall J, Lacroix J, Stelfox T, Bagshaw S, Choong K, Lamontagne F, Turgeon AF, Lapinsky S, Ahern SP, Smith O, Siddiqui F, Jouvet P, Khwaja K, McIntyre L, Menon K, Hutchison J, Hornstein D, Joffe A, Lauzier F, Singh J, Karachi T, Wiebe K, Olafson K, Ramsey C, Sharma S, Dodek P, , , , Canadian Critical Care Trials Group H1N1 Collaborative, et al.: Critically ill patients with 2009 influenza A (H1N1) infection in Canada. JAMA 2009, 302(17):1872-9.
• [9]The ANZIC Influenza Investigators: Clinical care services and 2009 H1N1 influenza in Australia and New Zealand. N Engl J Med 2009, 361(20):1925-1934.
• [10]Antonelli M, Conti G, Rocco M, Bufi M, De Blasi RA, Vivino G, Gasparetto A, Meduri GU: A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med 1998, 339(7):429-435.
• [11]Rodrigues PM, Carmo Neto E, Santos LR, Knibel MF: Ventilator-associated pneumonia: epidemiology and impact on the clinical evolution of ICU patients. J Bras Pneumol 2009, 35(11):1084-91.
• [12]Levine S, Nguyen T, Taylor N, Friscia ME, Budak MT, Rothenberg P, Zhu J, Sachdeva R, Sonnad S, Kaiser LR, Rubinstein NA, Powers SK, Shrager JB: Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med 2008, 358(13):1327-1335.
• [13]Keenan SP, Mehta S: Noninvasive ventilation for patients presenting with acute respiratory failure: the randomized controlled trials. Respir Care 2009, 54(1):116-26.
• [14]CDC protocol of real-time RTPCR for influenza A (H1N1) [http:/ / www.who.int/ csr/ resources/ publications/ swineflu/ CDCRealtimeRTPCR_SwineH1Assay-2009_ 20090430.pdf] webciteGeneva: World Health Organization;
• [15]Pabbaraju K, Wong S, Wong AA, Appleyard GD, Chui L, Pang XL, Yanow SK, Fonseca K, Lee BE, Fox JD, Preiksaitis JK: Design and validation of real-time reverse transcription-PCR assays for detection of pandemic (H1N1) 2009 virus. J Clin Microbiol 2009, 47(11):3454-3460.
• [16]R Development Core Team: R: A language and environment for statistical computing. [http://www.R-project.org] webciteR Foundation for Statistical Computing, Vienna, Austria;
• [17]Cheung TM, Yam LY, So LK, Lau AC, Poon E, Kong BM, Yung RW: Effectiveness of noninvasive positive pressure ventilation in the treatment of acute respiratory failure in severe acute respiratory syndrome. Chest 2004, 126(3):845-850.
• [18]American Association for Respiratory Care: AARC SARS guidance document. [http://www.aarc.org/resources/sars/sars%20aarc%20guidance%20document.pdf] webcite 2003.