Pandemic 2009 Influenza A in Argentina: A Study of 337 Patients on Mechanical Ventilation
Abstract
Rationale: The rapid spread of the 2009 Influenza A (H1N1) around the world underscores the need for a better knowledge of epidemiology, clinical features, outcomes, and mortality predictors, especially in the most severe presentations. Objectives: To describe these characteristics in patients with confirmed, probable, and suspected viral pneumonia caused by 2009 influenza A (H1N1) admitted to 35 intensive care units with acute respiratory failure requiring mechanical ventilation in Argentina, between June 3 and September 7. Methods: Inception-cohort study including 337 consecutive adult patients. Data were collected in a form posted on the Argentinian Society of Intensive Care website. Measurements and Main Results: Proportions of confirmed, probable, or suspected cases were 39%, 8%, and 53% and had similar outcomes. APACHE II was 18 ± 7; age 47 ± 17 years; 56% were male; and 64% had underlying conditions, with obesity (24%), chronic obstructive respiratory disease (18%), and immunosupression (15%) being the most common. Seven percent were pregnant. On admission, patients had severe hypoxemia (PaO2/FiO2 140 [87–200]), extensive lung radiologic infiltrates (2.87 ± 1.03 quadrants) and bacterial coinfection, (25%; mostly with Streptococcus pneumoniae). Use of adjuvants such as recruitment maneuvers (40%) and prone positioning (13%), and shock (72%) and acute kidney injury requiring hemodialysis (17%), were frequent. Mortality was 46%, and was similar across all ages. APACHE II, lowest PaO2/FiO2, shock, hemodialysis, prone positioning, and S. pneumoniae coinfection independently predicted death. Conclusions: Patients with 2009 influenza A (H1N1) requiring mechanical ventilation were mostly middle-aged adults, often with comorbidities, and frequently developed severe acute respiratory distress syndrome and multiorgan failure requiring advanced organ support. Case fatality rate was accordingly high.
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S. pneumoniae co-infection was associated with higher mortality (OR 2.72, 95% CI 1.05-7.06) in ICU patients with influenza, despite concurrent antibiotic treatment on admission.
“S.pneumoniae co-infection was associated with higher mortality (OR 2.72 95% CI 1.05–7.06), despite concurrent antibiotic treatment on admission [5].”
From The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza a(H1N1)pdm09. (2018) · cites this paper as [5]
In a large study in Argentina (n=337), 24% of ICU patients with ILI and ARF requiring mechanical ventilation had bacterial pneumonia on admission, and 8% had S. pneumoniae.
“In a large study involving admissions to 35 ICUs for ILI and ARF requiring mechanical ventilation in Argentina (n = 337), 24% of included patients had bacterial pneumonia on admission, 8% with S. pneumoniae [5].”
From The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza a(H1N1)pdm09. (2018) · cites this paper as [5]
Evidence from seasonal influenza epidemics, past pandemics, pathology studies and animal models shows influenza predisposes to bacterial co-infection.
“Evidence of influenza predisposing to bacterial co-infection is seen in seasonal influenza epidemics, past pandemics, pathology studies and animal models [1–8].”
From The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza a(H1N1)pdm09. (2018) · cites this paper as [5]
Two early reviews of severe 2009 pandemic influenza A(H1N1) showed no evidence of bacterial pneumonia among 30 hospitalized patients in California and 10 intensive-care patients in Michigan.
“However, two early reviews of severe cases of 2009 pandemic influenza A (H1N1) showed no evidence of bacterial pneumonia among 30 hospitalized patients with laboratory-confirmed cases in California (5) and 10 intensive-care patients in Michigan (6).”
From The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza a(H1N1)pdm09. (2018) · cites this paper as [5]
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- Authors
- Estenssoro, E., Ríos, F. G., Apezteguía, C., Reina, R., Neira, J., Ceraso, D. H., Orlandi, C., Valentini, R., Tiribelli, N., Brizuela, M., Balasini, C., Mare, S., Domeniconi, G., Ilutovich, S., Gómez, A., Giuliani, J., Barrios, C., & Valdez, P.
- Affiliations
- Hospital Interzonal San Martin de La Plata, Buenos Aires, Argentina
- Hospital Posadas (AR)
- Sanatorio de la Trinidad-Palermo, Buenos Aires, Argentina
- Hospital Fernández (AR)
- Sanatorio Lopez Lima, Gral. Roca, Río Negro, Argentina
- Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (AR)
- Hospital Churruca, Buenos Aires, Argentina
- Fundacion Allende (AR)
- Hospital Pirovano, Buenos Aires, Argentina
- Sanatorio Julio Mëndez; Buenos Aires, Argentina
- Sanatorio de la Trinidad-San Isidro, Provincia de Buenos Aires, Argentina
- Sanatorio de la Trinidad-Mitre, Buenos Aires, Argentina
- Clínica de Los Arcos, Buenos Aires, Argentina
- Hospital Italiano Garibaldi, Rosario, Argentina
- Sanatorio Franchin, Buenos Aires, Argentina; and
- Hospital Velez Sarsfield, Buenos Aires, Argentina
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-07-01
- Volume
- 182
- Issue
- 1
- Pages
- 41-48
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W2090332825
- Semantic Scholar
- 1fca77d42c933e6b2f8beee1b97266d783c6bb17
- Cited by
- 230
- References
- 45
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 7 · 2023: 7 · 2022: 9 · 2021: 7 · 2020: 22 · 2019: 3 · 2018: 13 · 2017: 9 · 2016: 8 · 2015: 9 · 2014: 13 · 2013: 30 · 2012: 34
- FWCI
- 26.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- 2009 H1N1 influenza A, pandemic influenza, mechanical ventilation, acute respiratory failure, viral pneumonia, mortality risk factors, APACHE II score, acute respiratory distress syndrome, multiple organ failure, bacterial co-infection, shock, acute kidney injury, prone positioning, recruitment maneuvers, hypoxemia, Argentina
- MeSH terms
- Adult, Hypoxia, Argentina, Disease Outbreaks, Female, Humans, Influenza, Human, Male, Middle Aged, Pneumonia, Pneumococcal, Pregnancy, Respiration, Artificial, Respiratory Distress Syndrome, Cohort Studies, APACHE, Influenza A Virus, H1N1 Subtype
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