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Pandemic 2009 Influenza A in Argentina: A Study of 337 Patients on Mechanical Ventilation

Estenssoro, Elisa, Ríos, Fernando G., Apezteguía, Carlos, Reina, Rosa, Neira, Jorge, Ceraso, Daniel H., Orlandi, Cristina, Valentini, Ricardo, Tiribelli, Norberto, Brizuela, Matías, Balasini, Carina, Mare, Sebastián, Domeniconi, Gustavo, Ilutovich, Santiago, Gómez, Alejandro, Giuliani, Javiera, Barrios, Cecilia, Valdez, Pascual·2010·American Journal of Respiratory and Critical Care Medicine

DOI 10.1164/201001-0037oc

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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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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
ORCID: Estenssoro, Elisa
Valentini, Ricardo
Balasini, Carina
Domeniconi, Gustavo
Valdez, Pascual
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
DOI: 10.1164/201001-0037oc
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
Licence: academic.oup.com/pages/standard-publication-reuse-rights (vor)
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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Pandemic 2009 Influenza A in Argentina: A Study of 337 Patients on Mechanical Ventilation

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