tetano
Editor, Senior Moderator
Respir Care. 2011 Feb 9. [Epub ahead of print]
Survival From Severe Pandemic H1N1 in Urban and Rural Turkey: A Case Series.
Kirakli C, Tatar D, Cimen P, Edipoglu O, Coskun M, Celikten E, Ozsoz A.
Abstract
BACKGROUND: Pandemic influenza A (H1N1) was a serious health problem during the winter of 2009-2010 in Turkey. We aimed to clarify the clinical and demographic characteristics of patients who needed critical care management in our region.
METHODS: We conducted a prospective cohort study from November 2009 to February 2010 of demographic characteristics, clinical course, management strategies, 28-day mortality and length of stay in the ICU.
RESULTS: Eighteen patients (10 female) with a median (IQR) age of 39 (24-52) years and APACHE II score of 16 (10-25), nine of them living in rural places (50%) were followed up in the ICU during the study period. All patients had ALI or ARDS. The most common risk factors for severe H1N1 infection were obesity (33%), chronic obstructive pulmonary disease (16%) and pregnancy (11%). Thirteen patients (72%) needed mechanical ventilation support at the time of ICU admission. Mortality was 50% (9/18) at day 28. There were a significant number of survivors from urban, as compared to rural areas (82% vs 0%, p=0.0007). There were also statistically significant differences between survivors and nonsurvivors in terms of success of noninvasive ventilation, time to confirmation of the virus from the admission to the ICU, creatinine, LDH, pH, PaCO₂ levels and PaO₂/FiO₂ ratio.
CONCLUSIONS: The most common clinical presentation was ALI/ARDS in pandemic influenza A (H1N1) patients who needed critical care management. Living in rural areas might have affected the access to advanced ICU facilities and early ventilatory support. Failure of noninvasive ventilation, late diagnosis and antiviral therapy, high APACHE II scores and living in rural areas were associated with mortality.
http://www.ncbi.nlm.nih.gov/pubmed/21310115
Survival From Severe Pandemic H1N1 in Urban and Rural Turkey: A Case Series.
Kirakli C, Tatar D, Cimen P, Edipoglu O, Coskun M, Celikten E, Ozsoz A.
Abstract
BACKGROUND: Pandemic influenza A (H1N1) was a serious health problem during the winter of 2009-2010 in Turkey. We aimed to clarify the clinical and demographic characteristics of patients who needed critical care management in our region.
METHODS: We conducted a prospective cohort study from November 2009 to February 2010 of demographic characteristics, clinical course, management strategies, 28-day mortality and length of stay in the ICU.
RESULTS: Eighteen patients (10 female) with a median (IQR) age of 39 (24-52) years and APACHE II score of 16 (10-25), nine of them living in rural places (50%) were followed up in the ICU during the study period. All patients had ALI or ARDS. The most common risk factors for severe H1N1 infection were obesity (33%), chronic obstructive pulmonary disease (16%) and pregnancy (11%). Thirteen patients (72%) needed mechanical ventilation support at the time of ICU admission. Mortality was 50% (9/18) at day 28. There were a significant number of survivors from urban, as compared to rural areas (82% vs 0%, p=0.0007). There were also statistically significant differences between survivors and nonsurvivors in terms of success of noninvasive ventilation, time to confirmation of the virus from the admission to the ICU, creatinine, LDH, pH, PaCO₂ levels and PaO₂/FiO₂ ratio.
CONCLUSIONS: The most common clinical presentation was ALI/ARDS in pandemic influenza A (H1N1) patients who needed critical care management. Living in rural areas might have affected the access to advanced ICU facilities and early ventilatory support. Failure of noninvasive ventilation, late diagnosis and antiviral therapy, high APACHE II scores and living in rural areas were associated with mortality.
http://www.ncbi.nlm.nih.gov/pubmed/21310115