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

The DOI matches its Crossref record; 47 of the 47 references it cites were found in a registry or an index.

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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Metadata

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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