title: Characteristics and outcome of mechanically ventilated patients with 2009 H1N1 influenza in Bosnia and Herzegovina and Serbia: impact of newly established multidisciplinary intensive care units.
abstract: OBJECTIVE
  To describe characteristics and outcome of mechanically ventilated patients admitted to three newly established intensive care units (ICU) in Bosnia-Herzegovina and Serbia for 2009 H1N1 influenza infection.
  
  
  METHODS
  The retrospective observational study included all mechanically ventilated adult patients of three university-affiliated hospitals between November 1, 2009 and March 1 2010 who had 2009 H1N1 influenza infection confirmed by real-time reverse transcriptase-polymerase-chain-reaction (RT-PCR) from nasopharyngeal swab specimens and respiratory secretions.
  
  
  RESULTS
  The study included 50 patients, 31 male (62%), aged 43±13 years. Median time from hospital to ICU admission was 1 day (range 1-2). Sixteen patients (30%) presented with one or more chronic medical condition: 8 (16%) with chronic lung disease, 5 (10%) with chronic heart failure, and 3 (6%) with diabetes mellitus. Thirty-two (64%) were obese. Forty-eight patients (96%) experienced acute respiratory distress syndrome (ARDS), 28 (56%) septic shock, and 27 (54%) multiorgan failure. Forty-five patients (90%) were intubated and mechanically ventilated, 5 received non-invasive mechanical ventilation, 7 (14%) high-frequency oscillatory ventilation, and 7 (14%) renal replacement therapy. The median duration of mechanical ventilation was 7 (4-14) days. Hospital mortality was 52%.
  
  
  CONCLUSIONS
  Influenza 2009 H1N1 infection in three southeast European ICUs affected predominantly healthy young patients and was associated with rapid deterioration after hospital admission and severe respiratory and multiorgan failure. These emerging ICUs provided contemporary ICU services, resulting in case-fatality rate comparable to reports from well-established ICU settings.
authors.affiliation: Medical Intensive Care Unit, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
authors.forename: Marija
authors.initials: M
authors.lastname: Kojicić
authors.forename: Pedja
authors.initials: P
authors.lastname: Kovacević
authors.forename: Nermina
authors.initials: N
authors.lastname: Bajramović
authors.forename: Uros
authors.initials: U
authors.lastname: Batranović
authors.forename: Jadranka
authors.initials: J
authors.lastname: Vidović
authors.forename: Kenana
authors.initials: K
authors.lastname: Aganović
authors.forename: Srdjan
authors.initials: S
authors.lastname: Gavrilović
authors.forename: Biljana
authors.initials: B
authors.lastname: Zlojutro
authors.forename: Guillaume
authors.initials: G
authors.lastname: Thiery
mesh_terms: D000328:Adult; D017522:Bosnia and Herzegovina / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D009305:Nasopharynx / Q000821:virology; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D055771:Serbia / Q000453:epidemiology