title: A surge of flu-associated adult respiratory distress syndrome in an Austrian tertiary care hospital during the 2009/2010 Influenza A H1N1v pandemic.
abstract: We report on 17 patients with influenza A H1N1v-associated Adult Respiratory Distress Syndrome who were admitted to the intensive care unit (ICU) between June 11th 2009 and August 10th 2010 (f/m: 8/9; age: median 39 (IQR 29-54) years; SAPS II: 35 (29-48)). Body mass index was 26 (24-35), 24% were overweight and 29% obese. The Charlson Comorbidity Index was 1 (0-2) and all but one patient had comorbid conditions. The median time between onset of the first symptom and admission to the ICU was 5 days (range 0-14). None of the patients had received vaccination against H1N1v. Nine patients received oseltamivir, only two of them within 48 hours of symptom onset. All patients developed severe ARDS (PaO(2)/FiO(2)-Ratio 60 (55-92); lung injury score 3.8 (3.3-4.0)), were mechanically ventilated and on vasopressor support. Fourteen patients received corticosteroids, 7 patients underwent hemofiltration, and 10 patients needed extracorporeal membrane-oxygenation (ECMO; 8 patients veno-venous, 2 patients veno-arterial), three patients Interventional Lung Assist (ILA) and two patients pump driven extracorporeal low-flow CO(2)-elimination (ECCO(2)-R). Seven of 17 patients (41%) died in the ICU (4 patients due to bleeding, 3 patients due to multi-organ failure), while all other patients survived the hospital (59%). ECMO mortality was 50%. The median ICU length-of-stay was 26 (19-44) vs. 21 (17-25) days (survivors vs. nonsurvivors), days on the ventilator were 18 (14-35) vs. 20 (17-24), and ECMO duration was 10 (8-25) vs. 13 (11-16) days, respectively (all p = n.s.). Compared to a control group of 241 adult intensive care unit patients without H1N1v, length of stay in the ICU, rate of mechanical ventilation, days on the ventilator, and TISS 28 scores were significantly higher in patients with H1N1v. The ICU survival tended to be higher in control patients (79 vs. 59%; p = 0.06). Patients with H1N1v admitted to either of our ICUs were young, overproportionally obese and almost all with existing comorbidities. All patients developed severe ARDS, which could only be treated with extracorporeal gas exchange in an unexpectedly high proportion. Patients with H1N1v had more complicated courses compared to control patients.
authors.affiliation: Department of Medicine I, Intensive Care Unit, Comprehensive Cancer Center, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Schellongowski
authors.forename: Roman
authors.initials: R
authors.lastname: Ullrich
authors.forename: Cornelia
authors.initials: C
authors.lastname: Hieber
authors.forename: Hubert
authors.initials: H
authors.lastname: Hetz
authors.forename: Heidrun
authors.initials: H
authors.lastname: Losert
authors.forename: Maria
authors.initials: M
authors.lastname: Hermann
authors.forename: Alexander
authors.initials: A
authors.lastname: Hermann
authors.forename: Klaus-Bernhard
authors.initials: KB
authors.lastname: Gattringer
authors.forename: Viktoria
authors.initials: V
authors.lastname: Siersch
authors.forename: Werner
authors.initials: W
authors.lastname: Rabitsch
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuhrmann
authors.forename: Andja
authors.initials: A
authors.lastname: Bojic
authors.forename: Oliver
authors.initials: O
authors.lastname: Robak
authors.forename: Wolfgang R
authors.initials: WR
authors.lastname: Sperr
authors.forename: Klaus
authors.initials: K
authors.lastname: Laczika
authors.forename: Gottfried J
authors.initials: GJ
authors.lastname: Locker
authors.forename: Thomas
authors.initials: T
authors.lastname: Staudinger
mesh_terms: D000328:Adult; D001317:Austria / Q000453:epidemiology; D015984:Causality; D021821:Communicable Diseases, Emerging / Q000453:epidemiology*; D015897:Comorbidity; D004194:Disease; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult