Tweet
JAMA. Critically Ill Patients With 2009 Influenza A(H1N1) in Mexico
Critically Ill Patients With 2009 Influenza A(H1N1) in Mexico (JAMA, abstract, edited)
Critically Ill Patients With 2009 Influenza A(H1N1) in Mexico
Guillermo Dom?nguez-Cherit, MD; Stephen E. Lapinsky, MB, BCh, MSc; Alejandro E. Macias, MD; Ruxandra Pinto, PhD(Stat); Lourdes Espinosa-Perez, MD; Alethse de la Torre, MD; Manuel Poblano-Morales, MD; Jose A. Baltazar-Torres, MD; Edgar Bautista, MD; Abril Martinez, MD; Marco A. Martinez, MD; Eduardo Rivero, MD; Rafael Valdez, MD; Guillermo Ruiz-Palacios, MD; Mart?n Hern?ndez, MD; Thomas E. Stewart, MD; Robert A. Fowler, MD, MS(Epi)
JAMA. 2009;302(17):1880-1887.
Published online October 12, 2009 (doi:10.1001/jama.2009.1536).
Context
In March 2009, novel 2009 influenza A(H1N1) was first reported in the southwestern United States and Mexico. The population and health care system in Mexico City experienced the first and greatest early burden of critical illness.
Objective
To describe baseline characteristics, treatment, and outcomes of consecutive critically ill patients in Mexico hospitals that treated the majority of such patients with confirmed, probable, or suspected 2009 influenza A(H1N1).
Design, Setting, and Patients
Observational study of 58 critically ill patients with 2009 influenza A(H1N1) at 6 hospitals between March 24 and June 1, 2009. Demographic data, symptoms, comorbid conditions, illness progression, treatments, and clinical outcomes were collected using a piloted case report form.
Main Outcome Measures
The primary outcome measure was mortality. Secondary outcomes included rate of 2009 influenza (A)H1N1?related critical illness and mechanical ventilation as well as intensive care unit (ICU) and hospital length of stay.
Results
Critical illness occurred in 58 of 899 patients (6.5%) admitted to the hospital with confirmed, probable, or suspected 2009 influenza (A)H1N1. Patients were young (median, 44.0 [range, 10-83] years); all presented with fever and all but 1 with respiratory symptoms. Few patients had comorbid respiratory disorders, but 21 (36%) were obese. Time from hospital to ICU admission was short (median, 1 day [interquartile range {IQR}, 0-3 days]), and all patients but 2 received mechanical ventilation for severe acute respiratory distress syndrome and refractory hypoxemia (median day 1 ratio of PaO2 to fraction of inspired oxygen, 83 [IQR, 59-145] mm Hg). By 60 days, 24 patients had died (41.4%; 95% confidence interval, 28.9%-55.0%). Patients who died had greater initial severity of illness, worse hypoxemia, higher creatine kinase levels, higher creatinine levels, and ongoing organ dysfunction. After adjusting for a reduced opportunity of patients dying early to receive neuraminidase inhibitors, neuraminidase inhibitor treatment (vs no treatment) was associated with improved survival (odds ratio, 8.5; 95% confidence interval, 1.2-62.8).
Conclusion
Critical illness from 2009 influenza A(H1N1) in Mexico occurred in young individuals, was associated with severe acute respiratory distress syndrome and shock, and had a high case-fatality rate.
Author Affiliations:
Division of Pulmonary and Critical Care (Dr Dom?nguez-Cherit), Hospital Epidemiology Department (Drs de la Torre and Macias), Infectious Disease Department (Dr Ruiz-Palacios), and Department of Critical Care Medicine (Dr Rivero), Instituto Nacional de Ciencias M?dicas y Nutrici?n "Salvador Zubir?n," M?xico City, M?xico; Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto and Mount Sinai Hospital, Toronto, Ontario, Canada (Dr Lapinsky); School of Medicine, Instituto Tecnologico de Estudios Superiores de Monterrey, Monterrey, M?xico (Dr Espinosa-Perez); Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto and Sunnybrook Health Sciences Centre, Toronto (Dr Pinto); Hospital Juarez de M?xico, M?xico City (Dr Poblano-Morales); Hospital de Especialidades Centro Medico La Raza, IMSS, M?xico City (Dr Baltazar-Torres); Instituto Nacional de Enfermedades Respiratorias, M?xico City (Dr Bautista); Department of Internal Medicine (Drs A. Martinez and M. A. Martinez) and Infectious Disease Hospital (Dr Valdez), Hospital General "Dr. Manuel Gea Gonzalez," M?xico City; Hospital San Jose-Tec de Monterrey, Monterrey City (Dr Hern?ndez); Interdepartmental Division of Critical Care Medicine and Department of Medicine and Anaesthesia, University of Toronto, Mount Sinai Hospital, University Health Network, Toronto (Dr Stewart); and Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto and Sunnybrook Health Sciences Centre, Toronto (Dr Fowler).
-
<cite cite="http://jama.ama-assn.org/cgi/content/abstract/302/17/1880?etoc">JAMA -- Abstract: Critically Ill Patients With 2009 Influenza A(H1N1) in Mexico, November 4, 2009, Dom?nguez-Cherit et al. 302 (17): 1880</cite>
Guillermo Dom?nguez-Cherit, MD; Stephen E. Lapinsky, MB, BCh, MSc; Alejandro E. Macias, MD; Ruxandra Pinto, PhD(Stat); Lourdes Espinosa-Perez, MD; Alethse de la Torre, MD; Manuel Poblano-Morales, MD; Jose A. Baltazar-Torres, MD; Edgar Bautista, MD; Abril Martinez, MD; Marco A. Martinez, MD; Eduardo Rivero, MD; Rafael Valdez, MD; Guillermo Ruiz-Palacios, MD; Mart?n Hern?ndez, MD; Thomas E. Stewart, MD; Robert A. Fowler, MD, MS(Epi)
JAMA. 2009;302(17):1880-1887.
Published online October 12, 2009 (doi:10.1001/jama.2009.1536).
Context
In March 2009, novel 2009 influenza A(H1N1) was first reported in the southwestern United States and Mexico. The population and health care system in Mexico City experienced the first and greatest early burden of critical illness.
Objective
To describe baseline characteristics, treatment, and outcomes of consecutive critically ill patients in Mexico hospitals that treated the majority of such patients with confirmed, probable, or suspected 2009 influenza A(H1N1).
Design, Setting, and Patients
Observational study of 58 critically ill patients with 2009 influenza A(H1N1) at 6 hospitals between March 24 and June 1, 2009. Demographic data, symptoms, comorbid conditions, illness progression, treatments, and clinical outcomes were collected using a piloted case report form.
Main Outcome Measures
The primary outcome measure was mortality. Secondary outcomes included rate of 2009 influenza (A)H1N1?related critical illness and mechanical ventilation as well as intensive care unit (ICU) and hospital length of stay.
Results
Critical illness occurred in 58 of 899 patients (6.5%) admitted to the hospital with confirmed, probable, or suspected 2009 influenza (A)H1N1. Patients were young (median, 44.0 [range, 10-83] years); all presented with fever and all but 1 with respiratory symptoms. Few patients had comorbid respiratory disorders, but 21 (36%) were obese. Time from hospital to ICU admission was short (median, 1 day [interquartile range {IQR}, 0-3 days]), and all patients but 2 received mechanical ventilation for severe acute respiratory distress syndrome and refractory hypoxemia (median day 1 ratio of PaO2 to fraction of inspired oxygen, 83 [IQR, 59-145] mm Hg). By 60 days, 24 patients had died (41.4%; 95% confidence interval, 28.9%-55.0%). Patients who died had greater initial severity of illness, worse hypoxemia, higher creatine kinase levels, higher creatinine levels, and ongoing organ dysfunction. After adjusting for a reduced opportunity of patients dying early to receive neuraminidase inhibitors, neuraminidase inhibitor treatment (vs no treatment) was associated with improved survival (odds ratio, 8.5; 95% confidence interval, 1.2-62.8).
Conclusion
Critical illness from 2009 influenza A(H1N1) in Mexico occurred in young individuals, was associated with severe acute respiratory distress syndrome and shock, and had a high case-fatality rate.
Author Affiliations:
Division of Pulmonary and Critical Care (Dr Dom?nguez-Cherit), Hospital Epidemiology Department (Drs de la Torre and Macias), Infectious Disease Department (Dr Ruiz-Palacios), and Department of Critical Care Medicine (Dr Rivero), Instituto Nacional de Ciencias M?dicas y Nutrici?n "Salvador Zubir?n," M?xico City, M?xico; Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto and Mount Sinai Hospital, Toronto, Ontario, Canada (Dr Lapinsky); School of Medicine, Instituto Tecnologico de Estudios Superiores de Monterrey, Monterrey, M?xico (Dr Espinosa-Perez); Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto and Sunnybrook Health Sciences Centre, Toronto (Dr Pinto); Hospital Juarez de M?xico, M?xico City (Dr Poblano-Morales); Hospital de Especialidades Centro Medico La Raza, IMSS, M?xico City (Dr Baltazar-Torres); Instituto Nacional de Enfermedades Respiratorias, M?xico City (Dr Bautista); Department of Internal Medicine (Drs A. Martinez and M. A. Martinez) and Infectious Disease Hospital (Dr Valdez), Hospital General "Dr. Manuel Gea Gonzalez," M?xico City; Hospital San Jose-Tec de Monterrey, Monterrey City (Dr Hern?ndez); Interdepartmental Division of Critical Care Medicine and Department of Medicine and Anaesthesia, University of Toronto, Mount Sinai Hospital, University Health Network, Toronto (Dr Stewart); and Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto and Sunnybrook Health Sciences Centre, Toronto (Dr Fowler).
-