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Intensive Care Medicine

, Volume 36, Issue 6, pp 1015–1022 | Cite as

Critically ill infants and children with influenza A (H1N1) in pediatric intensive care units in Argentina

  • 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
Pediatric Original

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.

Keywords

Critically ill Influenza A (H1N1) Infants and children Mechanical ventilation Survey 

Notes

Acknowledgment

We are grateful to Brian Kavanagh for his comments and suggestions on the manuscript. This study was in part supported by the Sociedad Argentina de Terapia Intensiva (SATI).

Conflict of interest statement

The authors have no conflicts of interest to disclose.

References

  1. 1.
    Ministerio de Salud de Argentina (2009) Influenza pandémica H1N1. http://municipios.msal.gov.ar/h1n1/parte_influenza/parte-65-fecha-05-08-09.pdf
  2. 2.
    Monteverde E, Fernandez A, Farias JA (2009) Segundo Estudio Internacional de la Ventilación Mecanica en Pediatría. Medicina Intensiva (Argentina) 26:32 (abstract)Google Scholar
  3. 3.
    WHO (2009) Human infection with pandemic (H1N1) 2009 virus: updated interim WHO guidance on global surveillance. http://www.who.int/csr/disease/swineflu/WHO_case_definition_swine_flu_2009_04_29.pdf
  4. 4.
    Slater A, Shann F, Pearson G (2003) PIM2: a revised version of the Paediatric Index of Mortality. Intensive Care Med 29:278–285PubMedGoogle Scholar
  5. 5.
    Feudtner C, Christakis DA, Connell FA (2000) Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington State, 1980–1997. Pediatrics 106:205–209PubMedGoogle Scholar
  6. 6.
    Farias JA, Frutos-Vivar F, Casado Flores J, Siaba A, Retta A, Fernandez A, Baltodano A, Ko IJ, Johnson M, Esteban A (2006) Factors associated with the prognosis of mechanically ventilated infants and children. An international study. Med Intensiva 30:425–431CrossRefPubMedGoogle Scholar
  7. 7.
    Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R (1994) The American–European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149:818–824PubMedGoogle Scholar
  8. 8.
    Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36:309–332CrossRefPubMedGoogle Scholar
  9. 9.
    Goldstein B, Giroir B, Randolph A (2005) International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 6:2–8CrossRefPubMedGoogle Scholar
  10. 10.
    Rana S, Jenad H, Gay P, Buck C, Hubmayr R, Gajic O (2006) Failure of non-invasive ventilation in patients with acute lung injury: observational cohort study. Crit Care 10:R 79CrossRefGoogle Scholar
  11. 11.
    Festic E, Gajic O, Limper AH, Aksamit TR (2005) Acute respiratory failure due to pneumocystis pneumonia in patients without human immunodeficiency virus infection. Chest 128:573–579CrossRefPubMedGoogle Scholar
  12. 12.
    The ANZIC Influenza Investigators (2009) Critical care services and 2009 H1N1 influenza in Australia and New Zealand. N Engl J Med 361:1925–1934CrossRefGoogle Scholar
  13. 13.
    Kumar A, Zarychanski R, Pinto R, Cook DJ, Marshall J, Lacroix J, Stelfox T, Bagshaw S, Choong K, Lamontagne F, Turgeon AF, Lapinsky S, Ahern SP, Smith O, Siddiqui F, Jouvet P, Khwaja K, McIntyre L, Menon K, Hutchison J, Hornstein D, Joffe A, Lauzier F, Singh J, Karachi T, Wiebe K, Olafson K, Ramsey C, Sharma S, Dodek P, Meade M, Hall R, Fowler R (2009) Critically ill patients with 2009 Influenza A (H1N1) infection in Canada. JAMA 302:1872–1879CrossRefPubMedGoogle Scholar
  14. 14.
    Dominguez-Cherit G, Lapinsky SE, Macias AE, Pinto R, Espinosa-Perez L, de la Torre A, Poblano-Morales M, Baltazar-Torres JA, Bautista E, Martinez A, Martinez MA, Rivero E, Valdez R, Ruiz-Palacios G, Hernandez M, Stewart TE, Fowler RA (2009) Critically ill patients with 2009 Influenza A (H1N1) in Mexico. JAMA 302:1880–1887CrossRefPubMedGoogle Scholar
  15. 15.
    Dahlem P, van Aalderen WM, Hamaker ME, Dijkgraaf MG, Bos AP (2003) Incidence and short-term outcome of acute lung injury in mechanically ventilated children. Eur Respir J 22:980–985CrossRefPubMedGoogle Scholar
  16. 16.
    Flori HR, Glidden DV, Rutherford GW, Matthay MA (2005) Pediatric acute lung injury: prospective evaluation of risk factors associated with mortality. Am J Respir Crit Care Med 171:995–1001CrossRefPubMedGoogle Scholar
  17. 17.
    Lister P, Reynolds F, Parslow R, Chan A, Cooper M, Plunkett A, Riphagen S, Peters M (2009) Swine-origin influenza virus H1N1, seasonal influenza virus, and critical illness in children. Lancet 374:605–607CrossRefPubMedGoogle Scholar
  18. 18.
    Caprotta G, Gonzalez Crotti P, Primucci Y, Alesio H, Esen A (2010) Influenza A H1N1 respiratory infection in an intensive care unit in Argentina. An Pediatr (Barc) 72:62–66Google Scholar
  19. 19.
    Rello J, Rodriguez A, Ibanez P, Socias L, Cebrian J, Marques A, Guerrero J, Ruiz-Santana S, Marquez E, Del Nogal-Saez F, Alvarez-Lerma F, Martinez S, Ferrer M, Avellanas M, Granada R, Maravi-Poma E, Albert P, Sierra R, Vidaur L, Ortiz P, Prieto Del Portillo I, Galvan B, Leon-Gil C (2009) Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1) in Spain. Crit Care 13:R148CrossRefPubMedGoogle Scholar
  20. 20.
    Centers for Disease Control and Prevention (CDC) (2009) Intensive-care patients with severe novel Influenza A (H1N1) virus infection—Michigan, June 2009. MMWR Morb Mortal Wkly Rep 58:749–752Google Scholar
  21. 21.
    Vaillant L, La Ruche G, Tarantola A, Barboza P (2009) Epidemiology of fatal cases associated with pandemic H1N1 influenza 2009. Euro Surveill 14:pii-19309Google Scholar
  22. 22.
    Centers for Disease Control and Prevention (CDC) (2009) Surveillance for pediatric deaths associated with pandemic Influenza A H1N1 virus infection—United States, April–August 2009. MMWR Morb Mortal Wkly Rep 58:941–947Google Scholar
  23. 23.
    Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, Hernandez M, Quinones-Falconi F, Bautista E, Ramirez-Venegas A, Rojas-Serrano J, Ormsby CE, Corrales A, Higuera A, Mondragon E, Cordova-Villalobos JA (2009) Pneumonia and respiratory failure from swine-origin Influenza A (H1N1) in Mexico. N Engl J Med 361:680–689CrossRefPubMedGoogle Scholar
  24. 24.
    Dawood FS, Jain S, Finelli L, Shaw MW, Lindstrom S, Garten RJ, Gubareva LV, Xu X, Bridges CB, Uyeki TM (2009) Emergence of a novel swine-origin Influenza A (H1N1) virus in humans. N Engl J Med 360:2605–2615CrossRefPubMedGoogle Scholar
  25. 25.
    Raffo L (2009) Influenza A (H1N1) epidemic in Argentina. Experience in a National General Hospital (Hospital Nacional Alejandro Posadas). Medicina (B Aires) 69:393–423Google Scholar
  26. 26.
    Kandun IN, Tresnaningsih E, Purba WH, Lee V, Samaan G, Harun S, Soni E, Septiawati C, Setiawati T, Sariwati E, Wandra T (2008) Factors associated with case fatality of human H5N1 virus infections in Indonesia: a case series. Lancet 372:744–749CrossRefPubMedGoogle Scholar
  27. 27.
    Sato M, Saito R, Sato I, Tanabe N, Shobugawa Y, Sasaki A, Li D, Suzuki Y, Sato M, Sakai T, Oguma T, Tsukada H, Gejyo F, Suzuki H (2008) Effectiveness of oseltamivir treatment among children with Influenza A or B virus infections during four successive winters in Niigata City, Japan. Tohoku J Exp Med 214:113–120CrossRefPubMedGoogle Scholar
  28. 28.
    Kawai N, Ikematsu H, Iwaki N, Maeda T, Satoh I, Hirotsu N, Kashiwagi S (2006) A comparison of the effectiveness of oseltamivir for the treatment of Influenza A and Influenza B: a Japanese multicenter study of the 2003–2004 and 2004–2005 influenza seasons. Clin Infect Dis 43:439–444CrossRefPubMedGoogle Scholar
  29. 29.
    Lin JT, Yu XZ, Cui DJ, Chen XY, Zhu JH, Wang YZ, Wu XD (2006) A multicentre, randomized, controlled trial of oseltamivir in the treatment of influenza in a high-risk Chinese population. Curr Med Res Opin 22:75–82CrossRefPubMedGoogle Scholar
  30. 30.
    Kaiser L, Wat C, Mills T, Mahoney P, Ward P, Hayden F (2003) Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations. Arch Intern Med 163:1667–1672CrossRefPubMedGoogle Scholar
  31. 31.
    Shun-Shin M, Thompson M, Heneghan C, Perera R, Harnden A, Mant D (2009) Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials. BMJ 339:b3172CrossRefPubMedGoogle Scholar
  32. 32.
    McGeer A, Green KA, Plevneshi A, Shigayeva A, Siddiqi N, Raboud J, Low DE (2007) Antiviral therapy and outcomes of influenza requiring hospitalization in Ontario, Canada. Clin Infect Dis 45:1568–1575CrossRefPubMedGoogle Scholar
  33. 33.
    Libster R, Bugna J, Coviello S, Hijano DR, Dunaiewsky M, Reynoso N, Cavalieri ML, Guglielmo MC, Areso MS, Gilligan T, Santucho F, Cabral G, Gregorio GL, Moreno R, Lutz MI, Panigasi AL, Saligari L, Caballero MT, Egues Almeida RM, Gutierrez Meyer ME, Neder MD, Davenport MC, Del Valle MP, Santidrian VS, Mosca G, Garcia Dominguez M, Alvarez L, Landa P, Pota A, Bolonati N, Dalamon R, Sanchez Mercol VI, Espinoza M, Peuchot JC, Karolinski A, Bruno M, Borsa A, Ferrero F, Bonina A, Ramonet M, Albano LC, Luedicke N, Alterman E, Savy V, Baumeister E, Chappell JD, Edwards KM, Melendi GA, Polack FP (2010) Pediatric Hospitalizations Associated with 2009 Pandemic Influenza A (H1N1) in Argentina. N Engl J Med 362:45–55Google Scholar

Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Julio A. Farias
    • 1
  • Analía Fernández
    • 1
  • Ezequiel Monteverde
    • 1
  • Nilda Vidal
    • 2
  • Pilar Arias
    • 3
  • María J. Montes
    • 4
  • Gabriela Rodríguez
    • 5
  • Mariela Allasia
    • 6
  • Maria E. Ratto
    • 7
  • Roxana Jaén
    • 8
  • Claudia Meregalli
    • 9
  • Karina Fiquepron
    • 10
  • Ana R. Calvo
    • 11
  • Alejandro Siaba
    • 12
  • Lidia Albano
    • 2
  • Rossana Poterala
    • 13
  • Pablo Neira
    • 13
  • Andrés Esteban
    • 14
  1. 1.Unidad de Cuidados Intensivos PediátricosHospital de Niños R GutiérrezBuenos AiresArgentina
  2. 2.Unidad de Cuidados Intensivos PediátricosHospital A PosadasHaedo, Buenos AiresArgentina
  3. 3.Unidad de Cuidados Intensivos PediátricosSanatorio FranchinBuenos AiresArgentina
  4. 4.Unidad de Cuidados Intensivos PediátricosHospital de Niños de la Sma TrinidadCórdobaArgentina
  5. 5.Unidad de Cuidados Intensivos PediátricosHospital F AbeteBuenos AiresArgentina
  6. 6.Unidad de Cuidados Intensivos PediátricosHospital de Niños O AllasiaSanta FeArgentina
  7. 7.Unidad de Cuidados Intensivos PediátricosHospital de Niños Sor LudovicaLa Plata, Buenos AiresArgentina
  8. 8.Unidad de Cuidados Intensivos PediátricosHospital de Clinicas J de San MartinBuenos AiresArgentina
  9. 9.Unidad de Cuidados Intensivos PediátricosHospital de Niños P ElizaldeBuenos AiresArgentina
  10. 10.Unidad de Cuidados Intensivos PediátricosHospital El CruceFlorencio Varela, Buenos AiresArgentina
  11. 11.Unidad de Cuidados Intensivos PediátricosHospital del Niño JesúsSan Miguel de Tucumán, TucumánArgentina
  12. 12.Unidad de Cuidados Intensivos PediátricosHospital AustralPilar, Buenos AiresArgentina
  13. 13.Unidad de Cuidados Intensivos PediátricosSanatorio AnchorenaBuenos AiresArgentina
  14. 14.Unidad de Cuidados IntensivosHospital Universitario de GetafeMadridEspaña

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