Trujillo-Ramírez N, Villagómez OAJ, Rosas BJV, Reyes MR, Guzmán GR, Reséndiz GS

Language: Spanish
References: 18
Page: 197-205
PDF size: 122.08 Kb.

ABSTRACT

Background: The emergence of the influenza H1N1 virus in 2009 and the serious complications concomitant began the debate to define the optimal treatment. Given that the mechanism causing of death is the «cytokine storm», we believe that activated protein C may improve the prognosis of these patients.
Objective: To evaluate whether the use of activated protein C reduces mortality in patients with septic shock by severe acute pneumonia influenza virus.
Material and methods: Historical cohort study which compared two groups of patients admitted to intensive care unit with septic shock by acute pneumonia by influenza A H1N1 and seasonal influenza virus, a group received standard treatment and the other standard treatment plus Activated protein C.
Results: We studied 29 patients; 18 were given activated protein C and 11 conventional management alone. In univariate analysis raw results show that patients with the use of protein C had higher mortality at 30 days with a p = 0.018.
Discussion: The result should be viewed cautiously given the small number of patients, heterogeneity, time of admission to ICU and the type of study.
Conclusion: The use of activated protein C increased mortality in this group of patients with viral infection source.

REFERENCES

1. Villagómez OAJ. La pandemia de Influenza A H1N1: ¿la pandemia esperada? Rev Asoc Mex Med Crit Ter Int. 2010;24:6-7.

2. Trexler HM. In The Clinic Influenza. Annals of Internal Medicine 2009;ITC5-1-16.

3. Biere B, Schweiger B, Nitsche A. Influenza A H1N1 diagnostics: the first, the fastest, and the most reliable. Lancet Infect Dis 2009;9:721-722.

4. Harper S, Bradley J, Englund J, File T, Gravenstein S, et al. Seasonal Influenza in Adults and Children Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management: Clinical Practice Guidelines of the Infectious Diseases Society of America. CID 2009;48:1003-1032.

5. Guía provisional sobre recolección de muestras, procesamiento y pruebas en pacientes presuntamente infectados con el virus de la nueva influenza A (H1N1).

6. http://espanol.cdc.gov/enes/h1n1flu/update.htm. 2010:1:08.

7. Fajardo-Dolci GE, Hernández-Torres F, Santacruz-Varela J, Rodríguez-Suárez J, Lamy P, et al. Perfil epidemiológico de la mortalidad por influenza humana A (H1N1) en México. Salud Pública de México 2009;51:361-371.

8. Rothberg M, Haessler S, Brown R. Complications of Viral Influenza. Am J Med 2008;121:258-264.

9. Rothberg M, Haessler S. Complications of seasonal and pandemic influenza. Crit Care Med 2010;38[Suppl.] DOI: 10.1097/CCM.0b013e3181c92eeb.

10. Acciones para contener la transmisión de influenza A (H1N1) en el país. SSA. 2009.

11. Meduri GU, Golden E, Freire A, Taylor E, et al. Methylprednisolone Infusion in Early Severe ARDS. CHEST 2007;131:954-963.

12. Carter MJ. A rationale for using steroids in the treatment of severe cases of H5N1 avian influenza. Journal of Medical Microbiology 2007;56:875–883.

13. Jong D, Simmons C, Thanh T, Hien V, Smith G, et al. Fatal outcome of human influenza A (H5N1) is associated with high viral load and hypercytokinemia. Nat Med 2006;12:1203-1207.

14. Bermejo-Martin J F, Ortiz de Lejarazu R, Pumarola T, Rello J, Almansa R, et al. Th1 and Th17 hypercytokinemia as early host response signature in severe pandemic influenza. Critical Care 2009;13.

15. Remick DG. Pathophysiology of sepsis. Am J Pathol 2007;170:1435-1444.

16. Bernard GR, Vincent JL, Laterre PF, La Rosa SP, Dhainaut JF, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 2001;10: 699-709.

17. Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon SL, Hernandez M, Quiñones-Falconi F, et al. Pneumonia and Respiratory Failure from Swine-Origin Influenza A (H1N1) in Mexico. N Engl J Med 2009;361:680-689.

18. Restrepo M, Anzueto A. Severe community-acquired pneumonia. Infect Dis Clin N Am 2009;23:503–520.