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Vol. 42. Num. 8.November 2018
Pages e19-e22Pages 461-516
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Vol. 42. Num. 8.November 2018
Pages e19-e22Pages 461-516
ORIGINAL
DOI: 10.1016/j.medine.2018.08.002
Patients with influenza A (H1N1)pdm09 admitted to the ICU. Impact of the recommendations of the SEMICYUC
Pacientes con gripe por el virus influenza A (H1N1)pdm09 ingresados en la UCI. Impacto de las recomendaciones de la SEMICYUC
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J. Marin-Corrala,b,
Corresponding author
jmarincorral@gmail.com

Corresponding author.
, C. Climenta,b, R. Muñoza,b, M. Sampera,b, I. Dota,b, C. Vilàa,b, J.R. Masclansa,b,c,d, A. Rodriguezd,e, I. Martin-Loechesf, F. Álvarez-Lermaa,b,c, on behalf of the H1N1 Working Group GETGAG SEMICYUC
a Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, Spain
b Grupo de Investigación en Patología Crítica (GREPAC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
c Universitat Autònoma de Barcelona, Barcelona, Spain
d Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
e Servicio de Medicina Intensiva, Hospital Universitario Joan XXIII, Institut d’Investigació Sanitària Pere Virgili (IISPV)-Universitat Rovira i Virgili (URV), Tarragona, Spain
f Service of Intensive Care Medicine, St. James's Hospital, Dublin, Ireland
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Tables (3)
Table 1. Descriptive characteristics of the patients admitted to the ICU with influenza A (H1N1)pdm09 infection in the two epidemic periods.
Table 2. Characteristics related to the recommendations of the SEMICYUC 2012 in the patients admitted to the ICU with influenza A (H1N1)pdm09 infection in the two epidemic periods.
Table 3. Factors independently associated to patient mortality in the two epidemic periods of the study.
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Abstract
Objectives

To evaluate the impact of the recommendations of the SEMICYUC (2012) on severe influenza A.

Design

A prospective multicenter observational study was carried out.

Setting

ICU.

Patients

Patients infected with severe influenza A (H1N1) from the GETGAG/SEMICYUC registry.

Interventions

Analysis of 2 groups according to the epidemic period of the diagnosis (2009–2011; 2013–2015).

Variables

Demographic, temporal, comorbidities, severity, treatments, mortality, late diagnosis and place of acquisition.

Results

A total of 2205 patients were included, 1337 (60.6%) in the first period and 868 (39.4%) in the second one. Age and severity on admission were significantly greater in the second period, as well as co-infection. With regard to the impact of the recommendations, in the second period the diagnosis was established earlier (70.8 vs. 61.1%, p<0.001), without changes in the start of treatment. Patients received less corticosteroid treatment (39.7 vs. 44.9%, p<0.05), more NIMV was used (47.4 vs. 33.2%, p<0.001) and more vaccination was made (11.1 vs. 1.7%, p<0.001), without changes in mortality (24.2 vs. 20.7%). A decrease in nosocomial infection was also noted (9.8 vs. 16%, p<0.001). Patients needed less MV with more days of ventilation, more vasopressor drug use and more ventral decubitus.

Conclusions

The management of patients with severe influenza A (H1N1) has changed over the years, though without changes in mortality. The recommendations of the SEMICYUC (2012) have allowed earlier diagnosis and improved corticosteroid use. Pending challenges are the delay in treatment, the vaccination rate and the use of NIMV.

Keywords:
Influenza A (H1N1)pdm09 virus infection
Mortality
Critically illness
Outcome
Therapeutic management
Intensive Care Unit
Resumen
Objetivos

Evaluar el impacto de las recomendaciones SEMICYUC 2012 en la gripe A grave.

Diseño

Prospectivo multicéntrico observacional.

Ámbito

UCI.

Pacientes

Pacientes con virus influenza A (H1N1) grave (registro GETGAG/SEMICYUC).

Intervenciones

Análisis de 2 grupos según el periodo epidémico del diagnóstico (2009-2011; 2013-2015).

Variables

Demográficas, temporales, comorbilidades, gravedad, tratamientos, mortalidad, diagnóstico tardío y lugar de adquisición.

Resultados

Se incluyeron 2.205 pacientes, 1.337 (60,6%) en el primer periodo y 868 (39,4%) en el segundo. La edad, la gravedad al ingreso y la coinfección bacteriana fueron significativamente mayores en el segundo periodo. Respecto al impacto de las recomendaciones, en el segundo periodo el diagnóstico fue más precoz (70,8 vs. 61,1%, p<0,001), sin cambios en el inicio del tratamiento. Se administraron menos corticoides (39,7 vs. 44,9%, p<0,05), se utilizó más VMNI (47,4 vs. 33,2%, p<0,001) y se objetivó una mayor tasa de vacunación (11,1 vs. 1,7%, p<0,001), sin cambios en la mortalidad (24,2 vs. 20,7%). También se evidenció una disminución de la infección adquirida en el hospital (9,8 vs. 16%, p<0,001). Asimismo, los pacientes requirieron menos VM con más días de ventilación, más vasopresores y más decúbito prono.

Conclusiones

El manejo de los pacientes con gripe A (H1N1) grave se ha modificado con los años, sin cambios en la mortalidad. Las recomendaciones de la SEMICYUC del año 2012 han mejorado el diagnóstico precoz y el uso de corticoides. Queda por mejorar el retraso en el tratamiento, la tasa de vacunación y la utilización de la VMNI.

Palabras clave:
Infección por virus influenza A (H1N1)pdm09
Mortalidad
Enfermedad crítica
Pronóstico
Manejo terapéutico
Unidad de Cuidados Intensivos

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