Intensive Care Medicine

, Volume 36, Issue 1, pp 33–41

H1N1 influenza A virus-associated acute lung injury: response to combination oseltamivir and prolonged corticosteroid treatment

  • Adolfo Maximo Quispe-Laime
  • Jonas Daniel Bracco
  • Patricia Alejandra Barberio
  • Claudio German Campagne
  • Verónica Edith Rolfo
  • Reba Umberger
  • Gianfranco Umberto Meduri
Original

DOI: 10.1007/s00134-009-1727-6

Cite this article as:
Quispe-Laime, A.M., Bracco, J.D., Barberio, P.A. et al. Intensive Care Med (2010) 36: 33. doi:10.1007/s00134-009-1727-6

Abstract

Purpose

During the 2009 H1N1 influenza A virus pandemic, a minority of patients developed rapidly progressive pneumonia leading to acute lung injury (ALI)—acute respiratory distress syndrome (ARDS). A recent meta-analysis provides support for prolonged corticosteroid treatment in ALI-ARDS. We prospectively evaluated the response to oseltamivir and prolonged corticosteroid treatment in patients with ALI-ARDS and suspected H1N1 influenza.

Methods

From June 24 through 12 July 2009, 13 patients with suspected H1N1 pneumonia and ALI-ARDS were admitted to the intensive care unit (ICU) of a tertiary care hospital. H1N1 influenza was confirmed with real-time reverse transcriptase-polymerase chain reaction assay in eight patients. Oseltamivir and corticosteroid treatment were initiated concomitantly at ICU admission; those with severe ARDS received methylprednisolone (1 mg/kg/day), and others received hydrocortisone (300 mg/day) for a duration of 21 ± 6 days.

Results

Patients with and without confirmed H1N1 influenza had similar disease severity at presentation and a comparable response to treatment. By day 7 of treatment, patients experienced a significant improvement in lung injury and multiple organ dysfunction scores (P < 0.001). Twelve patients (92%) improved lung function, were extubated, and discharged alive from the ICU. Hospital length of stay and mortality were 18.7 ± 9.6 days and 15%, respectively. Survivors were discharged home without oxygen supplementation.

Conclusions

In ARDS patients, with and without confirmed H1N1 influenza, prolonged low-to-moderate dose corticosteroid treatment was well tolerated and associated with significant improvement in lung injury and multiple organ dysfunction scores and a low hospital mortality. These findings provide the rationale for developing a randomized trial.

Keywords

H1N1 influenza A virusAcute respiratory distress syndromeCorticosteroid treatmentMechanical ventilationMortality

Copyright information

© Copyright jointly hold by Springer and ESICM 2009

Authors and Affiliations

  • Adolfo Maximo Quispe-Laime
    • 1
  • Jonas Daniel Bracco
    • 1
  • Patricia Alejandra Barberio
    • 1
  • Claudio German Campagne
    • 1
  • Verónica Edith Rolfo
    • 1
  • Reba Umberger
    • 2
  • Gianfranco Umberto Meduri
    • 2
    • 3
  1. 1.Medical Intensive Care Unit, Dr. Leonidas Lucero Acute Municipal HospitalUniversidad Nacional del SurBahia BlancaArgentina
  2. 2.Memphis Veterans Affairs Medical CenterMemphisUSA
  3. 3.Division of Pulmonary, Critical Care, and Sleep MedicineUniversity of Tennessee Health Science CenterMemphisUSA