H1N1 influenza A virus-associated acute lung injury: response to combination oseltamivir and prolonged corticosteroid treatment.
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.
Quispe-Laime
Adolfo Maximo
AM
Medical Intensive Care Unit, Dr Leonidas Lucero Acute Municipal Hospital, Universidad Nacional del Sur, Bahia Blanca, Argentina.
Bracco
Jonas Daniel
JD
Barberio
Patricia Alejandra
PA
Campagne
Claudio German
CG
Rolfo
Verónica Edith
VE
Umberger
Reba
R
Meduri
Gianfranco Umberto
GU
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
D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D053139:Oseltamivir