title: Clinical characteristics of critically ill patients with suspected influenza during the 2009-10 and 2013-14 outbreaks.
abstract: Pandemic influenza A pdm09 (pH1N1) virus was the predominant isolate identified during the 2009-10 and 2013-14 influenza outbreaks, causing significant morbidity and mortality. We describe clinical characteristics of critically ill patients during 2 pH1N1 outbreaks.
  
  
  
  Single-center, retrospective cohort study of patients admitted to the intensive care unit receiving oseltamivir for suspected influenza during 2 outbreak periods. Demographics and comorbidities were collected from the medical record. Outcomes included use of adjunct oxygenation therapies and oseltamivir dosing.
  
  
  
  One hundred twenty-four patients were included (2009, n=53; 2013, n=71). Demographics were as follows: mean (SD) age, 52.3 (14.2) years; mean (SD) Acute Physiology and Chronic Health Evaluation II score, 19.4 (9.2); 71% had greater than or equal to 2 comorbidities; and mortality was 27%. Inhaled nitric oxide was administered more commonly in 2009 (P=.01), whereas neuromuscular blockade (P=.02) and epoprostenol were administered more commonly in 2013 (P=.01). Patients in 2009 were more likely to receive high-dose oseltamivir (P=.02; odds ratio, 1.8; 95% confidence interval, 1.18-6.62). No differences in clinical outcomes were observed between 2009 and 2013.
  
  
  
  Use of adjunct oxygenation therapies and nontraditional antiviral dosing has changed significantly since the 2009 pandemic, although this has not resulted in a measurable impact on clinical outcomes.
authors.affiliation: University of Maryland Medical Center, Baltimore, MD 21201.
authors.forename: Miguel J
authors.initials: MJ
authors.lastname: Franquiz
authors.affiliation: Institute of Human Virology, Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Saleeb
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland, School of Medicine, Baltimore, MD 21201.
authors.forename: Carl B
authors.initials: CB
authors.lastname: Shanholtz
authors.affiliation: University of Maryland Medical Center, Baltimore, MD 21201; Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD 21201. Electronic address: jgonzale@rx.umaryland.edu.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Gonzales
mesh_terms: D018806:APACHE; D000998:Antiviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003422:Critical Care; D016638:Critical Illness; D004196:Disease Outbreaks; D005260:Female; D006760:Hospitalization; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D007362:Intensive Care Units; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D053139:Oseltamivir / Q000627:therapeutic use; D012189:Retrospective Studies
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir
keywords: Critical illness; Influenza A virus, H1N1; Oseltamivir; Respiratory distress syndrome, adult/therapy