title: Severe acute respiratory infections in the postpandemic era of H1N1.
abstract: OBJECTIVE
  Shortly after the advent of severe acute respiratory syndrome and the avian influenza, the emergence of the influenza A(H1N1)2009 pandemic caused significant vibrations to the public health authorities and stressed the health systems worldwide. We sought to investigate whether this experience has altered our knowledge and our current and future practice on the management of severe acute respiratory infections (SARI) and community-acquired pneumonia.
  
  
  RESULTS
  A changing epidemiology was demonstrated, with obesity and pregnancy beyond established risk groups for influenza A, other clinical syndromes beyond primary viral pneumonia, possible coinfections by other viral beyond bacterial pathogens and a disappointing performance of all available severity assessment tools. On the treatment topic, accumulating evidence suggesting worse outcomes argues against the use of corticosteroids, but some noninvasive ventilating modalities require further assessment.
  
  
  CONCLUSIONS
  The recent influenza A(H1N1)2009 pandemic has highlighted our weaknesses relating to the diagnosis and assessment of severity of SARI, compromising early treatment and ultimate outcomes; further research based on this experience will help to improve prognosis and boost our future preparedness. An important message is the necessity of international collaboration for the rapid dissemination of locally acquired knowledge.
authors: Department of Critical Care, Vall d'Hebron University Hospital, Barcelona, Spain. gpoulakou@gmail.com
authors: Garyphallia
authors: G
authors: Poulakou
authors: Marcos
authors: M
authors: Pérez
authors: Jordi
authors: J
authors: Rello
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology*; D014943:Global Health; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000188:drug therapy / Q000453:epidemiology*; D011379:Prognosis; D011634:Public Health; D012128:Respiratory Distress Syndrome / Q000188:drug therapy / Q000453:epidemiology*; D012306:Risk; D045473:Severe acute respiratory syndrome-related coronavirus; D045169:Severe Acute Respiratory Syndrome / Q000188:drug therapy / Q000453:epidemiology*; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000305:Adrenal Cortex Hormones