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Vol. 35. Issue 4.
Pages 208-216 (January 2011)
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Vol. 35. Issue 4.
Pages 208-216 (January 2011)
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First influenza season after the 2009 pandemic influenza: report of the first 300 ICU admissions in Spain
Primera epidemia de gripe estacional después de la pandemia por gripe A en 2009: descripción de los primeros 300 ingresos en UCI espa¿nolas
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A. Rodrígueza,
Corresponding author
ahr1161@yahoo.es

Corresponding author.
, I. Martin-Loechesa, J. Bonastreb, P. Olaecheac, F. Álvarez-Lermad, R. Zaragozae, J. Guerrerof, J. Blancog, F. Gordoh, F. Pozoi, J. Lorentej, J. Carratalák, M. Corderol, J. Rellom, A. Estebani, C. Leónn, SEMICYUC-CIBERES-REIPI working group *
a Hospital Joan XXIII, Critical Care Department, IISPV, URV, CIBER Enfermedades Respiratorias, Tarragona, Spain
b Hospital La Fe, Critical Care Department, CIBER Enfermedades Respiratorias, Valencia, Spain
c Hospital Galdakao-Usansolo, Critical Care Department, CIBER Enfermedades Respiratorias, Vizcaya, Spain
d Hospital del Mar, Critical Care Department, CIBER Enfermedades Respiratorias, Barcelona, Spain
e Hospital Dr. Peset, Critical Care Department, Valencia, Spain
f Hospital Gregorio Mara¿nón, Critical Care Department, CIBER Enfermedades Respiratorias, Madrid, Spain
g Hospital Rio Hortega, Critical Care Department, CIBER Enfermedades Respiratorias, Valladolid, Spain
h Hospital del Henares, Critical Care Department, Madrid, Spain
i Pulmonology Department, Hospital 12 de Octubre, Madrid, Spain
j Hospital de Getafe, Critical Care Department, CIBER Enfermedades Respiratorias, Madird, Spain
k Hospital de Bellvitge, Infectious Disease Department, REIPI, L’Hospitalet de Llobregat, Barcelona, Spain
l Hospital Virgen del Rocío, Infectious Disease Department, REIPI, Sevilla, Spain
m Hospital Vall d’Hebron, Critical Care Department, IRVH, CIBER Enfermedades Respiratorias, Barcelona, Spain
n Critical Care Department, Hospital Universitario de Valme, Sevilla, Spain
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Abstract
Introduction

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.

Material 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.

Keywords:
An/H1N1 influenza
Critically ill patients
Prognostic
Resumen
Introducción

Durante la pandemia de gripe A, se publicaron diferentes comunicaciones. No obstante, el perfil clínico de los pacientes críticos afectados por este virus durante este segundo brote epidémico es poco conocido.

Material y métodos

Estudio prospectivo, observacional y multicéntrico realizado en 148 UCI espa¿nolas entre las semanas epidemiológicas 50 de 2010 y 4 de 2011.

Resultados

Se incluyó a los primeros 300 pacientes ingresados en UCI con infección confirmada por An/H1N1. La media de edad fue de 49 [38–58] a¿nos y el 62% eran varones. La media de APACHE II fue 16,9±7,5, con una media de SOFA de 6,3±3,5. El 76% (n=228) de los pacientes presentaron alguna comorbilidad, 111 (37,4%) eran obesos y 59 (20%) presentaban EPOC. La presentación clínica más habitual fue la neumonía viral con hipoxemia severa (65,7%; n=197), mientras que se observó coinfección en 54 pacientes (18%). Todos recibieron tratamiento antiviral, de forma empírica en 194 (65,3%). Sólo 53 pacientes (17,6%) recibieron tratamiento antiviral precoz; 22 pacientes (7,3%) estaban vacunados. Cumplieron su evolución en UCI 200 pacientes, y fallecieron 67 de ellos. La enfermedad hematológica, la gravedad general, los infiltrados en la radiografía de tórax y la necesidad de ventilación mecánica fueron las variables asociadas de forma independiente con la mortalidad.

Conclusiones

Los pacientes críticos ingresados en UCI durante el brote estacional de gripe pospandémica evidenciaron escaso nivel de vacunación, mayor frecuencia de comorbilidades, un nivel gravedad más elevado, mayor incidencia de neumonía viral primaria y una mortalidad superior en comparación con lo observado durante la pandemia de 2009.

Palabras clave:
Nueva Gripe An/H1N1
Pacientes críticos
Pronóstico
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*

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Copyright © 2011. Elsevier y Sociedad Española de Medicina Intensiva, Critica y Unidades Coronarias
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