Cited by 1,425Influenza Virus Research StudiesRespiratory Support and MechanismsRespiratory viral infections research

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Critically Ill Patients With 2009 Influenza A(H1N1) Infection in Canada

Kumar, Anand·2009·JAMA

DOI 10.1001/jama.2009.1496

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Abstract

CONTEXT: Between March and July 2009, the largest number of confirmed cases of 2009 influenza A(H1N1) infection occurred in North America. OBJECTIVE: To describe characteristics, treatment, and outcomes of critically ill patients in Canada with 2009 influenza A(H1N1) infection. DESIGN, SETTING, AND PATIENTS: A prospective observational study of 168 critically ill patients with 2009 influenza A(H1N1) infection in 38 adult and pediatric intensive care units (ICUs) in Canada between April 16 and August 12, 2009. MAIN OUTCOME MEASURES: The primary outcome measures were 28-day and 90-day mortality. Secondary outcomes included frequency and duration of mechanical ventilation and duration of ICU stay. RESULTS: Critical illness occurred in 215 patients with confirmed (n = 162), probable (n = 6), or suspected (n = 47) community-acquired 2009 influenza A(H1N1) infection. Among the 168 patients with confirmed or probable 2009 influenza A(H1N1), the mean (SD) age was 32.3 (21.4) years; 113 were female (67.3%) and 50 were children (29.8%). Overall mortality among critically ill patients at 28 days was 14.3% (95% confidence interval, 9.5%-20.7%). There were 43 patients who were aboriginal Canadians (25.6%). The median time from symptom onset to hospital admission was 4 days (interquartile range [IQR], 2-7 days) and from hospitalization to ICU admission was 1 day (IQR, 0-2 days). Shock and nonpulmonary acute organ dysfunction was common (Sequential Organ Failure Assessment mean [SD] score of 6.8 [3.6] on day 1). Neuraminidase inhibitors were administered to 152 patients (90.5%). All patients were severely hypoxemic (mean [SD] ratio of Pao(2) to fraction of inspired oxygen [Fio(2)] of 147 [128] mm Hg) at ICU admission. Mechanical ventilation was received by 136 patients (81.0%). The median duration of ventilation was 12 days (IQR, 6-20 days) and ICU stay was 12 days (IQR, 5-20 days). Lung rescue therapies included neuromuscular blockade (28% of patients), inhaled nitric oxide (13.7%), high-frequency oscillatory ventilation (11.9%), extracorporeal membrane oxygenation (4.2%), and prone positioning ventilation (3.0%). Overall mortality among critically ill patients at 90 days was 17.3% (95% confidence interval, 12.0%-24.0%; n = 29). CONCLUSION: Critical illness due to 2009 influenza A(H1N1) in Canada occurred rapidly after hospital admission, often in young adults, and was associated with severe hypoxemia, multisystem organ failure, a requirement for prolonged mechanical ventilation, and the frequent use of rescue therapies.

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Self-citation

Authors: Kumar, A.
Affiliations: Health Sciences Centre (CA)
Corresponding author: Kumar, Anand
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2009-11-04
Volume: 302
Issue: 17
Pages: 1872
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.2009.1496
OpenAlex: W2148958087
Cited by: 1,425
References: 47
Citations by year: 2026: 8 · 2025: 11 · 2024: 16 · 2023: 23 · 2022: 28 · 2021: 55 · 2020: 89 · 2019: 38 · 2018: 33 · 2017: 35 · 2016: 53 · 2015: 63 · 2014: 74 · 2013: 128 · 2012: 156
FWCI: 171.68
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Funders: American Thoracic Society
Alberta Health Services
Hamilton Health Sciences
McGill University
London Health Sciences Centre
McMaster University
BC Children's Hospital
McGill University Health Centre
University of Alberta
University of Toronto
Jewish General Hospital
Hospital for Sick Children
Canadian Institutes of Health Research
Topics: Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
Keywords: pandemic influenza, critically ill patients, intensive care, mortality, mechanical ventilation, hypoxemia, neuraminidase inhibitors, organ dysfunction, shock, Aboriginal Canadians, pediatric patients, treatment outcomes, Canada, influenza A (H1N1) 2009
MeSH terms: Adolescent, Adult, Aged, Aged, 80 and over, Hypoxia, Canada, Child, Child, Preschool, Disease Outbreaks, Female, Humans, Infant, Influenza, Human, Intensive Care Units, Length of Stay, Male, Middle Aged, Multiple Organ Failure, Prospective Studies, Respiration, Artificial, Respiratory Distress Syndrome, Comorbidity, Critical Illness, Age Distribution, Influenza A Virus, H1N1 Subtype, Kaplan-Meier Estimate, Young Adult

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Critically Ill Patients With 2009 Influenza A(H1N1) Infection in Canada

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