title: First influenza season after the 2009 pandemic influenza: report of the first 300 ICU admissions in Spain.
abstract: BACKGROUND
  During the 2009 influenza pandemic, several reports were published, nevertheless, data on the clinical profiles of critically ill patients with the new virus infection during this second outbreak are still lacking.
  
  
  METHODS
  Prospective, observational, multi-center study conducted in 148 Spanish intensive care units (ICU) during epidemiological weeks 50-52 of 2010 and weeks 1 - 4 of 2011.
  
  
  RESULTS
  Three hundred patients admitted to an intensive care unit (ICU) with confirmed An/H1N1 infection were analyzed. The median age was 49 years [IQR=38-58] and 62% were male. The mean APACHE II score was 16.9 ± 7.5 and the mean SOFA score was 6.3 ± 3.5 on admission. Comorbidities were present in 76% (n=228) of cases and 111 (37.4%) patients were reportedly obese and 59 (20%) were COPD. The main presentation was viral pneumonia with severe hypoxemia in 65.7% (n=197) of the patients whereas co-infection was identified in 54 (18%) patients. All patients received antiviral treatment and initiated empirically in 194 patients (65.3%), however only 53 patients (17.6%) received early antiviral treatment. Vaccination was only administered in 22 (7.3%) patients. Sixty-seven of 200 patients with ICU discharge died. Haematological disease, severity of illness, infiltrates in chest X-ray and need for mechanical ventilation were variables independently associated with ICU mortality.
  
  
  CONCLUSIONS
  In patients admitted to the ICU in the post-pandemic seasonal influenza outbreak vaccination was poorly implemented and appear to have higher frequency of severe comorbidities, severity of illness, incidence of primary viral pneumonia and increased mortality when compared with those observed in the 2009 pandemic outbreak.
authors.affiliation: Hospital Joan XXIII, Critical Care Department, IISPV, URV, CIBER Enfermedades Respiratorias, Tarragona, Spain. ahr1161@yahoo.es
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez
authors.forename: I
authors.initials: I
authors.lastname: Martin-Loeches
authors.forename: J
authors.initials: J
authors.lastname: Bonastre
authors.forename: P
authors.initials: P
authors.lastname: Olaechea
authors.forename: F
authors.initials: F
authors.lastname: Alvarez-Lerma
authors.forename: R
authors.initials: R
authors.lastname: Zaragoza
authors.forename: J
authors.initials: J
authors.lastname: Guerrero
authors.forename: J
authors.initials: J
authors.lastname: Blanco
authors.forename: F
authors.initials: F
authors.lastname: Gordo
authors.forename: F
authors.initials: F
authors.lastname: Pozo
authors.forename: J
authors.initials: J
authors.lastname: Lorente
authors.forename: J
authors.initials: J
authors.lastname: Carratalá
authors.forename: M
authors.initials: M
authors.lastname: Cordero
authors.forename: J
authors.initials: J
authors.lastname: Rello
authors.forename: A
authors.initials: A
authors.lastname: Esteban
authors.forename: C
authors.initials: C
authors.lastname: León
mesh_terms: D018806:APACHE; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000235:genetics / Q000302:isolation & purification; D007251:Influenza, Human / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D058873:Pandemics; D011024:Pneumonia, Viral / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D012042:Registries; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012769:Shock / Q000188:drug therapy / Q000209:etiology; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents