title: H1N1 influenza A virus-associated acute lung injury: response to combination oseltamivir and prolonged corticosteroid treatment.
abstract: OBJECTIVE
  During the 2009 H1N1 influenza A virus pandemic, a minority of patients developed rapidly progressive pneumonia leading to acute lung injury (ALI)-acute respiratory distress syndrome (ARDS). A recent meta-analysis provides support for prolonged corticosteroid treatment in ALI-ARDS. We prospectively evaluated the response to oseltamivir and prolonged corticosteroid treatment in patients with ALI-ARDS and suspected H1N1 influenza.
  
  
  METHODS
  From June 24 through 12 July 2009, 13 patients with suspected H1N1 pneumonia and ALI-ARDS were admitted to the intensive care unit (ICU) of a tertiary care hospital. H1N1 influenza was confirmed with real-time reverse transcriptase-polymerase chain reaction assay in eight patients. Oseltamivir and corticosteroid treatment were initiated concomitantly at ICU admission; those with severe ARDS received methylprednisolone (1 mg/kg/day), and others received hydrocortisone (300 mg/day) for a duration of 21 +/- 6 days.
  
  
  RESULTS
  Patients with and without confirmed H1N1 influenza had similar disease severity at presentation and a comparable response to treatment. By day 7 of treatment, patients experienced a significant improvement in lung injury and multiple organ dysfunction scores (P < 0.001). Twelve patients (92%) improved lung function, were extubated, and discharged alive from the ICU. Hospital length of stay and mortality were 18.7 +/- 9.6 days and 15%, respectively. Survivors were discharged home without oxygen supplementation.
  
  
  CONCLUSIONS
  In ARDS patients, with and without confirmed H1N1 influenza, prolonged low-to-moderate dose corticosteroid treatment was well tolerated and associated with significant improvement in lung injury and multiple organ dysfunction scores and a low hospital mortality. These findings provide the rationale for developing a randomized trial.
authors.affiliation: Medical Intensive Care Unit, Dr Leonidas Lucero Acute Municipal Hospital, Universidad Nacional del Sur, Bahia Blanca, Argentina.
authors.forename: Adolfo Maximo
authors.initials: AM
authors.lastname: Quispe-Laime
authors.forename: Jonas Daniel
authors.initials: JD
authors.lastname: Bracco
authors.forename: Patricia Alejandra
authors.initials: PA
authors.lastname: Barberio
authors.forename: Claudio German
authors.initials: CG
authors.lastname: Campagne
authors.forename: Verónica Edith
authors.initials: VE
authors.lastname: Rolfo
authors.forename: Reba
authors.initials: R
authors.lastname: Umberger
authors.forename: Gianfranco Umberto
authors.initials: GU
authors.lastname: Meduri
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001118:Argentina / Q000453:epidemiology; D002391:Catchment Area, Health; D004196:Disease Outbreaks; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology*; D007902:Length of Stay; D008168:Lung / Q000503:physiopathology / Q000821:virology; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000503:physiopathology; D053139:Oseltamivir / Q000627:therapeutic use; D011446:Prospective Studies; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D012720:Severity of Illness Index
chemical_list: D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D053139:Oseltamivir