Díaz GE, Rodríguez WF, Ojeda-López C, Salcido PP

Language: Spanish
References: 15
Page: 319-323
PDF size: 273.13 Kb.

ABSTRACT

Objective: To describe clinical and demographical factors in critically ill patients with influenza AH1N1 (s-AH1N1), and to evaluate the correct management, and the relation with mortality and morbidity.
Material and Method: Retrospective study of 29 critically ill patients with probable or confirmed infection (by PCR) with s-AH1N1 in Hospital Angeles Pedregal in Mexico city, infection that occurred between April and November of 2009.
Results: All studied patients were young (43 ± 16 years old), that presented fever, cough, dispnea, and cyanosis. The most frequent comorbidity associated was obesity, which occurred in 25% of cases. The patients that died were younger, had hypotension and elevated creatinine levels. All patients used neuraminidase inhibitors for five days, and antibiotic therapy, and three of them (37.5%) required mechanical ventilation.
Conclusions: Influenza A H1N1 virus has predisposition for young patients, especially if they have associated comorbidities, being more frequent the obesity. Patients with renal insufficiency and hypotension have worst prognosis. There is a better evolution in patients treated with antiviral drugs, antibiotics, and possibly intravenous steroid.

REFERENCES

1. Vaqué RJ, Gil CJ, Brotons AM. Principales características de la pandemia por el nuevo virus influenza A (H1N1). Medicina Clínica 2009;133(13):513-521.

2. Secretaría de Salud. Situación actual de la epidemia. http:// portal.salud.gob.mx/sites/salud/descargas/pdf/influenza/presentacion20091009.pdf. Accesado el 1 de febrero 2010.

3. Interim guidance on case definitions to be used for investigations of novel influenza A (H1N1) cases. Sitio de Centers for Disease Control and Prevention. http://www.cdc.gov/h1n1flu/ casedef.htm. Consultado el 4 de junio 2009.

4. Centers for Disease Control and Prevention. Update: novel infl uenza A (H1N1) virus infections-worldwide, May 6, 2009. MMWR Morb Mortal Wkly Rep. 2009;58:453–8.

5. World Health Organization. Situation updates - Pandemic (H1N1) 2009, 9 October, 2009. http://www.who.int/csr/don/2009_10_09/ en/index.html. Accesado el 4 de febrero 2010.

6. Kumar A, Zarychanski R, Pinto R, Cook DJ, et al. Critically Ill patients with 2009 Influenza A(H1N1) in Canada. JAMA 2009;302(17):1872-1879.

7. Chowell G, Bertozzi SM, Colchero MA, Lopez-Gatell H, et al. Severe respiratory disease concurrent with the circulation of H1N1 influenza. N Engl J Med 2009;361(7):674-679.

8. Domínguez-Cherit G, Lapinsky SE, Macias AE, et al. Critically Ill patients with 2009 Influenza A(H1N1) in Mexico. JAMA 2009;302(17):1880-1887.

9. World Health Organization. Weekly epidemiological record, 2009;84( 21):185-196.

10. British Infection Society; British Thoracic Society; Health Protection Agency; Department of Health. Pandemic Flu: Clinical management of patients with an influenza-like illness during an influenza pandemic. J Infect 2006;53 Suppl 1:S1-58.

11. World Health Organization. Situation updates - Pandemic (H1N1) 2009, 9 October, 2009. Disponible en: http://www. who.int/csr/don/2009_10_09/en/index.html. Accesado el 1 de febrero 2010.

12. Li G, Yilmaz M, Kojicic M, Fernández-Pérez E, et al. Outcome of critically ill patients with influenza virus infection. J Clin Virol 2009;46(3):275-278.

13. Meduri GU, Golden E, Freire AX, Taylor E, et al. Methylprednisolone infusion in early severe ARDS: Results of a randomized controlled trial. Chest 2007;131:954-963.

14. Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: A randomized controlled trial. JAMA 1998;280:159-165.

15. Steinberg KP, Hudson LD, Goodman RB, et al, for the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med 2006;354:1671-1684.