Published in:
01-06-2010 | Pediatric Original
Critically ill infants and children with influenza A (H1N1) in pediatric intensive care units in Argentina
Authors:
Julio A. Farias, Analía Fernández, Ezequiel Monteverde, Nilda Vidal, Pilar Arias, María J. Montes, Gabriela Rodríguez, Mariela Allasia, Maria E. Ratto, Roxana Jaén, Claudia Meregalli, Karina Fiquepron, Ana R. Calvo, Alejandro Siaba, Lidia Albano, Rossana Poterala, Pablo Neira, Andrés Esteban
Published in:
Intensive Care Medicine
|
Issue 6/2010
Login to get access
Abstract
Objective
To determine the epidemiological features, course, and outcomes of critically ill pediatric patients with Influenza A (H1N1) virus.
Design
Prospective cohort of children in pediatric intensive care units (PICUs) due to Influenza A (H1N1) virus infection.
Setting
Seventeen medical-surgical PICUs in tertiary care hospital in Argentina.
Patients
All consecutive patients admitted to the PICUs with influenza A (H1N1) viral infection from 15 June to 31 July 2009.
Measurements and main results
Of 437 patients with acute lower respiratory infection in PICUs, 147 (34%) were diagnosed with influenza A (H1N1) related to critical illness. The median age of these patients was 10 months (IQR 3–59). Invasive mechanical ventilation was used in 117 (84%) on admission. The rate of acute respiratory distress syndrome (ARDS) was 80% (118 of 147 patients). Initial non-invasive ventilation failed in 19 of 22 attempts (86%). Mortality at 28 days was 39% (n = 57). Chronic complex conditions (CCCs), acute renal dysfunction (ARD) and ratio PaO2/FiO2 at day 3 on MV were independently associated with a higher risk of mortality. The odds ratio (OR) for CCCs was 3.06, (CI 95% 1.36–6.84); OR for ARD, 3.38, (CI 95% 1.45–10.33); OR for PaO2/FiO2, 4 (CI 95% 1.57–9.59). The administration of oseltamivir within 24 h after admission had a protective effect: OR 0.2 (CI 95% 0.07–0.54).
Conclusions
In children with ARDS, H1N1 as an etiologic agent confers high mortality, and the presence of CCCs in such patients increases the risk of death.