title: Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)v in Spain.
abstract: BACKGROUND
  Patients with influenza A (H1N1)v infection have developed rapidly progressive lower respiratory tract disease resulting in respiratory failure. We describe the clinical and epidemiologic characteristics of the first 32 persons reported to be admitted to the intensive care unit (ICU) due to influenza A (H1N1)v infection in Spain.
  
  
  METHODS
  We used medical chart reviews to collect data on ICU adult patients reported in a standardized form. Influenza A (H1N1)v infection was confirmed in specimens using real-time reverse transcriptase-polymerase-chain-reaction (RT PCR) assay.
  
  
  RESULTS
  Illness onset of the 32 patients occurred between 23 June and 31 July, 2009. The median age was 36 years (IQR = 31 - 52). Ten (31.2%) were obese, 2 (6.3%) pregnant and 16 (50%) had pre-existing medical complications. Twenty-nine (90.6%) had primary viral pneumonitis, 2 (6.3%) exacerbation of structural respiratory disease and 1 (3.1%) secondary bacterial pneumonia. Twenty-four patients (75.0%) developed multiorgan dysfunction, 7 (21.9%) received renal replacement techniques and 24 (75.0%) required mechanical ventilation. Six patients died within 28 days, with two additional late deaths. Oseltamivir administration delay ranged from 2 to 8 days after illness onset, 31.2% received high-dose (300 mg/day), and treatment duration ranged from 5 to 10 days (mean 8.0 +/- 3.3).
  
  
  CONCLUSIONS
  Over a 5-week period, influenza A (H1N1)v infection led to ICU admission in 32 adult patients, with frequently observed severe hypoxemia and a relatively high case-fatality rate. Clinicians should be aware of pulmonary complications of influenza A (H1N1)v infection, particularly in pregnant and young obese but previously healthy persons.
authors.affiliation: Critical Care Department, Joan XXIII University Hospital, CIBERes Enfermedades Respiratorias, IISPV, Mallafre Guasch 4, 43007 Tarragona, Spain. jrello.hj23.ics@gencat.cat
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rodríguez
authors.forename: Pedro
authors.initials: P
authors.lastname: Ibañez
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Socias
authors.forename: Javier
authors.initials: J
authors.lastname: Cebrian
authors.forename: Asunción
authors.initials: A
authors.lastname: Marques
authors.forename: José
authors.initials: J
authors.lastname: Guerrero
authors.forename: Sergio
authors.initials: S
authors.lastname: Ruiz-Santana
authors.forename: Enrique
authors.initials: E
authors.lastname: Marquez
authors.forename: Frutos
authors.initials: F
authors.lastname: Del Nogal-Saez
authors.forename: Francisco
authors.initials: F
authors.lastname: Alvarez-Lerma
authors.forename: Sergio
authors.initials: S
authors.lastname: Martínez
authors.forename: Miquel
authors.initials: M
authors.lastname: Ferrer
authors.forename: Manuel
authors.initials: M
authors.lastname: Avellanas
authors.forename: Rosa
authors.initials: R
authors.lastname: Granada
authors.forename: Enrique
authors.initials: E
authors.lastname: Maraví-Poma
authors.forename: Patricia
authors.initials: P
authors.lastname: Albert
authors.forename: Rafael
authors.initials: R
authors.lastname: Sierra
authors.forename: Loreto
authors.initials: L
authors.lastname: Vidaur
authors.forename: Patricia
authors.initials: P
authors.lastname: Ortiz
authors.forename: Isidro
authors.initials: I
authors.lastname: Prieto del Portillo
authors.forename: Beatriz
authors.initials: B
authors.lastname: Galván
authors.forename: Cristóbal
authors.initials: C
authors.lastname: León-Gil
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000494:pharmacology; D003422:Critical Care; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000235:genetics*; D007251:Influenza, Human / Q000150:complications* / Q000821:virology; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009154:Mutation; D053139:Oseltamivir / Q000008:administration & dosage / Q000494:pharmacology; D011247:Pregnancy; D012131:Respiratory Insufficiency / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir