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Chen LL, Weng H. Clinical significance of lower respiratory tract culture within 48 h of admission in patients with viral pneumonia: an observational study. BMC Pulm Med 2024; 24:372. [PMID: 39085852 PMCID: PMC11293002 DOI: 10.1186/s12890-024-03162-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/11/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The aim of this retrospective study was to examine the risk factors of positive lower respiratory tract cultures and to investigate whether nosocomial infections are common in patients with positive lower respiratory tract cultures. METHODS We enrolled 86 patients diagnosed with influenza A-related critical illness who were treated at Fuzhou Pulmonary Hospital of Fujian in China between 1st October 2013 and 31st March 2019. The of admission were used to divide the enrolled patients into two groups. Sputum and bronchoalveolar lavage fluid specimens were collected within 48 h after admission for culture. All samples were cultured immediately after sampling. Nosocomial infections are defined as any symptom or sign of pulmonary infiltration, confirmed by X-ray, after 5 days of admission and positive results from one or more cultures. RESULTS The average age of this cohort was (54.13 ± 16.52) years. Based on the culture results, Staphylococcus aureus and Candida albicans had the highest positive rates (3.40% (3/86) and 20.90% (18/86), respectively). In patients with positive lower respiratory tract cultures, the incidence of nosocomial infection was 73.30% (22/30) five days after admission. However, the incidence of nosocomial infection was lower (42.80%, 24/56) in patients with negative lower respiratory tract cultures. Hemoptysis, systolic pressure at admission, and blood urea nitrogen level at admission were all independent risk factors for positive lower respiratory tract cultures within 48 h of admission. CONCLUSION Our data showed that a significant proportion of patients with pneumonia exhibited co-infections with bacteria or fungi within five days of hospital admission. Hemoptysis, systolic pressure, and blood urea nitrogen levels at admission emerged as the key risk factors. These findings underscore the necessity of closely monitoring patients with influenza infection, particularly for positive bacterial or fungal cultures within the initial 48 h of admission.
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Affiliation(s)
- Lu-Lu Chen
- Department of Respiratory Diseases, People' Hospital Affiliated to Fujian University of Traditional Chinese Medicine, No 602, 817 Middle Road, Taijiang District, Fuzhou, 350009, China
| | - Heng Weng
- Department of Respiratory Diseases, People' Hospital Affiliated to Fujian University of Traditional Chinese Medicine, No 602, 817 Middle Road, Taijiang District, Fuzhou, 350009, China.
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Abstract
Influenza infection causes severe illness in 3 to 5 million people annually, with up to an estimated 650,000 deaths per annum. As such, it represents an ongoing burden to health care systems and human health. Severe acute respiratory infection can occur, resulting in respiratory failure requiring intensive care support. Herein we discuss diagnostic approaches, including development of CLIA-waived point of care tests that allow rapid diagnosis and treatment of influenza. Bacterial and fungal coinfections in severe influenza pneumonia are associated with worse outcomes, and we summarize the approach and treatment options for diagnosis and treatment of bacterial and Aspergillus coinfection. We discuss the available drug options for the treatment of severe influenza, and treatments which are no longer supported by the evidence base. Finally, we describe the supportive management and ventilatory approach to patients with respiratory failure as a result of severe influenza in the intensive care unit.
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Affiliation(s)
- Liam S O'Driscoll
- Department of Intensive Care Medicine, St. James's University Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity Centre for Health Sciences, Dublin, Ireland
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, St. James's University Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity Centre for Health Sciences, Dublin, Ireland.,Respiratory Medicine, Hospital Clinic, IDIBAPS, Universidad de Barcelona, CIBERes, Barcelona, Spain
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3
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Smith RE, Shifrin MM. Critical Care Considerations in Adult Patients With Influenza-Induced ARDS. Crit Care Nurse 2021; 40:15-24. [PMID: 33000130 DOI: 10.4037/ccn2020746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
TOPIC Acute respiratory distress syndrome is a complex respiratory disease that can be induced by influenza virus infection. Critical care providers are uniquely positioned to manage this pathological progression in adult patients through evidence-based practice. CLINICAL RELEVANCE Influenza and subsequent acute respiratory distress syndrome are associated with extremely high morbidity and mortality in adult patients in the United States. Although evidence-based medical management strategies can alter the clinical trajectory of acute respiratory distress syndrome and improve outcomes, critical care providers do not always implement these measures. PURPOSE To provide critical care providers with an overview of the pathological progression of influenza-induced acute respiratory distress syndrome and the current evidence-based strategies for management. CONTENT COVERED This article reviews the epidemiology and pathophysiology associated with influenza-induced acute respiratory distress syndrome, the criteria for diagnosis, and the evidence-based medical management.
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Affiliation(s)
- Rachel E Smith
- Rachel E. Smith is an acute care nurse practitioner in the medical intensive care unit at Saint Thomas West Hospital, Nashville, Tennessee
| | - Megan M Shifrin
- Megan M. Shifrin is an assistant professor and the coordinator of the Adult-Gerontology Acute Care Nurse Practitioner Intensivist Focus at Vanderbilt University School of Nursing, Nashville, Tennessee
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4
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Martin-Loeches I, Lemiale V, Geoghegan P, McMahon MA, Pickkers P, Soares M, Perner A, Meyhoff TS, Bukan RB, Rello J, Bauer PR, van de Louw A, Taccone FS, Salluh J, Hemelaar P, Schellongowski P, Rusinova K, Terzi N, Mehta S, Antonelli M, Kouatchet A, Klepstad P, Valkonen M, Landburg PP, Barratt-Due A, Bruneel F, Pène F, Metaxa V, Moreau AS, Souppart V, Burghi G, Girault C, Silva UVA, Montini L, Barbier F, Nielsen LB, Gaborit B, Mokart D, Chevret S, Azoulay E. Influenza and associated co-infections in critically ill immunosuppressed patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:152. [PMID: 31046842 PMCID: PMC6498695 DOI: 10.1186/s13054-019-2425-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/09/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND It is unclear whether influenza infection and associated co-infection are associated with patient-important outcomes in critically ill immunocompromised patients with acute respiratory failure. METHODS Preplanned secondary analysis of EFRAIM, a prospective cohort study of 68 hospitals in 16 countries. We included 1611 patients aged 18 years or older with non-AIDS-related immunocompromise, who were admitted to the ICU with acute hypoxemic respiratory failure. The main exposure of interest was influenza infection status. The primary outcome of interest was all-cause hospital mortality, and secondary outcomes ICU length of stay (LOS) and 90-day mortality. RESULTS Influenza infection status was categorized into four groups: patients with influenza alone (n = 95, 5.8%), patients with influenza plus pulmonary co-infection (n = 58, 3.6%), patients with non-influenza pulmonary infection (n = 820, 50.9%), and patients without pulmonary infection (n = 638, 39.6%). Influenza infection status was associated with a requirement for intubation and with LOS in ICU (P < 0.001). Patients with influenza plus co-infection had the highest rates of intubation and longest ICU LOS. On crude analysis, influenza infection status was associated with ICU mortality (P < 0.001) but not hospital mortality (P = 0.09). Patients with influenza plus co-infection and patients with non-influenza infection alone had similar ICU mortality (41% and 37% respectively) that was higher than patients with influenza alone or those without infection (33% and 26% respectively). A propensity score-matched analysis did not show a difference in hospital mortality attributable to influenza infection (OR = 1.01, 95%CI 0.90-1.13, P = 0.85). Age, severity scores, ARDS, and performance status were all associated with ICU, hospital, and 90-day mortality. CONCLUSIONS Category of infectious etiology of respiratory failure (influenza, non-influenza, influenza plus co-infection, and non-infectious) was associated with ICU but not hospital mortality. In a propensity score-matched analysis, influenza infection was not associated with the primary outcome of hospital mortality. Overall, influenza infection alone may not be an independent risk factor for hospital mortality in immunosuppressed patients.
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Affiliation(s)
- Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland. .,Department of Clinical Medicine, Wellcome Trust-HRB Clinical Research Facility, St. James Hospital, Trinity College, Dublin, Ireland. .,Department of Intensive Care Medicine, St. James's Hospital, St. James's St, Dublin, Dublin 8, Ireland.
| | - Virginie Lemiale
- Medical Intensive Care Unit, Hôpital Saint-Louis and Paris Diderot Sorbonne University, Paris, France
| | - Pierce Geoghegan
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland.,Department of Clinical Medicine, Wellcome Trust-HRB Clinical Research Facility, St. James Hospital, Trinity College, Dublin, Ireland
| | - Mary Aisling McMahon
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland.,Department of Clinical Medicine, Wellcome Trust-HRB Clinical Research Facility, St. James Hospital, Trinity College, Dublin, Ireland
| | - Peter Pickkers
- Department of Intensive Care Medicine (710), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marcio Soares
- Department of Critical Care and Graduate Program in Translational Medicine, Programa de Pós-Graduação em Clínica Médica, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tine Sylvest Meyhoff
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ramin Brandt Bukan
- Department of Anesthesiology I, Herlev University Hospital, Herlev, Denmark
| | - Jordi Rello
- CIBERES, Universitat Autonòma de Barcelona, European Study Group of Infections in Critically Ill Patients (ESGCIP), Barcelona, Spain
| | - Philippe R Bauer
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andry van de Louw
- Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, PA, USA
| | - Fabio Silvio Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jorge Salluh
- Department of Critical Care and Graduate Program in Translational Medicine, Programa de Pós-Graduação em Clínica Médica, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Pleun Hemelaar
- Department of Intensive Care Medicine (710), Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Katerina Rusinova
- Department of Anesthesiology and Intensive Care Medicine and Institute for Medical Humanities, 1st Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Nicolas Terzi
- CHU Grenoble Alpes, Service de Réanimation Médicale, Faculté de Médecine de Grenoble, INSERM U1042, Université Grenoble-Alpes, Grenoble, France
| | - Sangeeta Mehta
- Department of Medicine and Interdepartmental Division of Critical Care Medicine, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Massimo Antonelli
- Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Achille Kouatchet
- Department of Medical Intensive Care Medicine, University Hospital of Angers, Angers, France
| | - Pål Klepstad
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Miia Valkonen
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Precious Pearl Landburg
- Department of Critical Care, University Medical Center Groningen, Groningen, The Netherlands
| | - Andreas Barratt-Due
- Department of Immunology-Department of Emergencies and Critical Care, University of Oslo, Oslo, Norway
| | - Fabrice Bruneel
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Frédéric Pène
- Medical ICU, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University Paris Descartes, Paris, France
| | - Victoria Metaxa
- Critical Care Department, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Anne Sophie Moreau
- Critical Care Center, CHU Lille, School of Medicine, University of Lille, Lille, France
| | - Virginie Souppart
- Medical Intensive Care Unit, Hôpital Saint-Louis and Paris Diderot Sorbonne University, Paris, France
| | - Gaston Burghi
- Terapia Intensiva, Hospital Maciel, Montevideo, Uruguay
| | - Christophe Girault
- Department of Medical Intensive Care, Normandie Univ, UNIROUEN, EA-3830, Rouen University Hospital, F-76000, Rouen, France
| | | | - Luca Montini
- Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francois Barbier
- Medical Intensive Care Unit, La Source Hospital - CHR Orléans, Orléans, France
| | - Lene B Nielsen
- Intensive Care Department, University of Southern Denmark, Sønderborg, Denmark.,Department of Anaesthesia and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Benjamin Gaborit
- Medical Intensive Care Unit, Hôtel Dieu-HME-University Hospital of Nantes, Nantes, France
| | - Djamel Mokart
- Réanimation Polyvalente et Département d'Anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Sylvie Chevret
- ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153, INSERM, Paris Diderot Sorbonne University and Service de Biostatistique et Information Médicale AP-HP, Hôpital Saint-Louis, Saint-Louis, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Hôpital Saint-Louis and Paris Diderot Sorbonne University, Paris, France
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Li SH, Hsieh MJ, Lin SW, Chuang LP, Lee CS, Chiu LC, Chang CH, Hu HC, Huang CC, Kao KC. Outcomes of severe H1N1 pneumoniae: A retrospective study at intensive care units. J Formos Med Assoc 2019; 119:26-33. [PMID: 30852002 DOI: 10.1016/j.jfma.2019.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 01/28/2019] [Accepted: 02/18/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The incidence of acute respiratory distress syndrome (ARDS) and the mortality rate of H1N1 influenza pneumonia are unclear. The aim of this study is to investigate the clinical features and outcomes of adult patients admitted to intensive care units (ICUs) with H1N1 pneumonia related ARDS. METHODS This retrospective study included patients with confirmed H1N1 influenza pneumonia admitted to the ICUs of a medical center between July 2009 and May 2014. We investigated the patients' characteristics, clinical presentations, illness severities, and outcomes. RESULTS Sixty-six patients were confirmed to have H1N1 influenza pneumonia requiring mechanical ventilation. Fifty-four of those patients (82%) developed ARDS, while their hospital mortality rate was 33% (22/66). There were no significant differences in the ICU and hospital mortality rates of the ARDS and non-ARDS patients. Among the ARDS patients, there were higher rates of solid malignant disease (22.8% vs. 2.8%, p = 0.038) and sepsis (66.7% vs. 33.3%, p = 0.020) and a higher mean tidal volume (8.9 ± 1.8 vs. 7.8 ± 1.9 ml/kg, p = 0.032) in the non-survivors than the survivors. Logistic regression analysis revealed that a high tidal volume (odds ratio = 1.448, 95 % CI = 1.033-2.030; p = 0.032) and sequential organ failure assessment (SOFA) score (odds ratio = 1.233, 95% CI = 1.029-1.478; p = 0.023) were the risk factors of hospital mortality. CONCLUSION For H1N1 influenza pneumonia patients admitted to ICUs with mechanical ventilation, there is a high probability of developing ARDS with a modest mortality rate. For patients with ARDS due to H1N1 influenza pneumonia, the tidal volume and SOFA score are the predictors of hospital mortality.
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Affiliation(s)
- Shih-Hong Li
- Department of Thoracic Medicine, Saint Paul's Hospital, Taoyuan, Taiwan; Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Meng-Jer Hsieh
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Wei Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Li-Pang Chuang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Shu Lee
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Li-Chung Chiu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Hao Chang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Han-Chung Hu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Chi Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Chin Kao
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Respiratory Viruses in Invasively Ventilated Critically Ill Patients-A Prospective Multicenter Observational Study. Crit Care Med 2017; 46:29-36. [PMID: 28991822 DOI: 10.1097/ccm.0000000000002752] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The presence of respiratory viruses and the association with outcomes were assessed in invasively ventilated ICU patients, stratified by admission diagnosis. DESIGN Prospective observational study. SETTING Five ICUs in the Netherlands. PATIENTS Between September 1, 2013, and April 30, 2014, 1,407 acutely admitted and invasively ventilated patients were included. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Nasopharyngeal swabs and tracheobronchial aspirates were collected upon intubation and tested for 14 respiratory viruses. Out of 1,407 patients, 156 were admitted because of a severe acute respiratory infection and 1,251 for other reasons (non-severe acute respiratory infection). Respiratory viruses were detected in 28.8% of severe acute respiratory infection patients and 17.0% in non-severe acute respiratory infection (p < 0.001). In one third, viruses were exclusively detected in tracheobronchial aspirates. Rhinovirus and human metapneumovirus were more prevalent in severe acute respiratory infection patients (9.6% and 2.6% vs 4.5 and 0.2%; p = 0.006 and p < 0.001). In both groups, there were no associations between the presence of viruses and the number of ICU-free days at day 28, crude mortality, and mortality in multivariate regression analyses. CONCLUSIONS Respiratory viruses are frequently detected in acutely admitted and invasively ventilated patients. Rhinovirus and human metapneumovirus are more frequently found in severe acute respiratory infection patients. Detection of respiratory viruses is not associated with worse clinically relevant outcomes in the studied cohort of patients.
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Influenza A (H1N1pdm09)-Related Critical Illness and Mortality in Mexico and Canada, 2014. Crit Care Med 2017; 44:1861-70. [PMID: 27359085 DOI: 10.1097/ccm.0000000000001830] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The 2009-2010 influenza A (H1N1pdm09) pandemic caused substantial morbidity and mortality among young patients; however, mortality estimates have been confounded by regional differences in eligibility criteria and inclusion of selected populations. In 2013-2014, H1N1pdm09 became North America's dominant seasonal influenza strain. Our objective was to compare the baseline characteristics, resources, and treatments with outcomes among critically ill patients with influenza A (H1N1pdm09) in Mexican and Canadian hospitals in 2014 using consistent eligibility criteria. DESIGN Observational study and a survey of available healthcare setting resources. SETTING Twenty-one hospitals, 13 in Mexico and eight in Canada. PATIENTS Critically ill patients with confirmed H1N1pdm09 during 2013-2014 influenza season. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The main outcome measures were 90-day mortality and independent predictors of mortality. Among 165 adult patients with H1N1pdm09-related critical illness between September 2013 and March 2014, mean age was 48.3 years, 64% were males, and nearly all influenza was community acquired. Patients were severely hypoxic (median PaO2-to-FIO2 ratio, 83 mm Hg), 97% received mechanical ventilation, with mean positive end-expiratory pressure of 14 cm H2O at the onset of critical illness and 26.7% received rescue oxygenation therapy with prone ventilation, extracorporeal life support, high-frequency oscillatory ventilation, or inhaled nitric oxide. At 90 days, mortality was 34.6% (13.9% in Canada vs 50.5% in Mexico, p < 0.0001). Independent predictors of mortality included lower presenting PaO2-to-FIO2 ratio (odds ratio, 0.89 per 10-point increase [95% CI, 0.80-0.99]), age (odds ratio, 1.49 per 10 yr increment [95% CI, 1.10-2.02]), and requiring critical care in Mexico (odds ratio, 7.76 [95% CI, 2.02-27.35]). ICUs in Canada generally had more beds, ventilators, healthcare personnel, and rescue oxygenation therapies. CONCLUSIONS Influenza A (H1N1pdm09)-related critical illness still predominantly affects relatively young to middle-aged patients and is associated with severe hypoxemic respiratory failure. The local critical care system and available resources may be influential determinants of patient outcome.
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Franquiz MJ, Saleeb PG, Shanholtz CB, Gonzales JP. Clinical characteristics of critically ill patients with suspected influenza during the 2009-10 and 2013-14 outbreaks. J Crit Care 2016; 38:73-77. [PMID: 27866108 DOI: 10.1016/j.jcrc.2016.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/28/2016] [Accepted: 10/17/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Pandemic influenza A pdm09 (pH1N1) virus was the predominant isolate identified during the 2009-10 and 2013-14 influenza outbreaks, causing significant morbidity and mortality. We describe clinical characteristics of critically ill patients during 2 pH1N1 outbreaks. METHODS Single-center, retrospective cohort study of patients admitted to the intensive care unit receiving oseltamivir for suspected influenza during 2 outbreak periods. Demographics and comorbidities were collected from the medical record. Outcomes included use of adjunct oxygenation therapies and oseltamivir dosing. RESULTS One hundred twenty-four patients were included (2009, n=53; 2013, n=71). Demographics were as follows: mean (SD) age, 52.3 (14.2) years; mean (SD) Acute Physiology and Chronic Health Evaluation II score, 19.4 (9.2); 71% had greater than or equal to 2 comorbidities; and mortality was 27%. Inhaled nitric oxide was administered more commonly in 2009 (P=.01), whereas neuromuscular blockade (P=.02) and epoprostenol were administered more commonly in 2013 (P=.01). Patients in 2009 were more likely to receive high-dose oseltamivir (P=.02; odds ratio, 1.8; 95% confidence interval, 1.18-6.62). No differences in clinical outcomes were observed between 2009 and 2013. CONCLUSIONS Use of adjunct oxygenation therapies and nontraditional antiviral dosing has changed significantly since the 2009 pandemic, although this has not resulted in a measurable impact on clinical outcomes.
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Affiliation(s)
| | - Paul G Saleeb
- Institute of Human Virology, Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Carl B Shanholtz
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland, School of Medicine, Baltimore, MD 21201
| | - Jeffrey P Gonzales
- University of Maryland Medical Center, Baltimore, MD 21201; Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD 21201.
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Martin-Loeches I, J Schultz M, Vincent JL, Alvarez-Lerma F, Bos LD, Solé-Violán J, Torres A, Rodriguez A. Increased incidence of co-infection in critically ill patients with influenza. Intensive Care Med 2016; 43:48-58. [DOI: 10.1007/s00134-016-4578-y] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 09/26/2016] [Indexed: 01/29/2023]
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Rello J, Manuel O, Eggimann P, Richards G, Wejse C, Petersen JE, Zacharowski K, Leblebicioglu H. Management of infections in critically ill returning travellers in the intensive care unit-II: clinical syndromes and special considerations in immunocompromised patients. Int J Infect Dis 2016; 48:104-12. [PMID: 27134159 PMCID: PMC7110459 DOI: 10.1016/j.ijid.2016.04.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/22/2016] [Accepted: 04/22/2016] [Indexed: 12/29/2022] Open
Abstract
This position paper is the second ESCMID Consensus Document on this subject and aims to provide intensivists, infectious disease specialists, and emergency physicians with a standardized approach to the management of serious travel-related infections in the intensive care unit (ICU) or the emergency department. This document is a cooperative effort between members of two European Society of Clinical Microbiology and Infectious Diseases (ESCMID) study groups and was coordinated by Hakan Leblebicioglu and Jordi Rello for ESGITM (ESCMID Study Group for Infections in Travellers and Migrants) and ESGCIP (ESCMID Study Group for Infections in Critically Ill Patients), respectively. A relevant expert on the subject of each section prepared the first draft which was then edited and approved by additional members from both ESCMID study groups. This article summarizes considerations regarding clinical syndromes requiring ICU admission in travellers, covering immunocompromised patients.
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Affiliation(s)
- Jordi Rello
- CIBERES, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oriol Manuel
- Infectious Diseases Service and Transplantation Centre, BH 10/553, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
| | - Philippe Eggimann
- Department of Adult Intensive Care Medicine, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Guy Richards
- University of the Witwatersrand, Johannesburg, South Africa
| | - Christian Wejse
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Hakan Leblebicioglu
- Infectious Disease Department, Ondokuz Mayis University Medical School, Samsun, Turkey
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12
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Wiesen J, Joshi D, Guzman JA, Duggal A. Critical illness associated with 2013-2014 influenza A (H1N1): Postpandemic characteristics, presentation and outcomes. Indian J Crit Care Med 2016; 19:636-41. [PMID: 26730113 PMCID: PMC4687171 DOI: 10.4103/0972-5229.169328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction: The United States experienced a postpandemic outbreak of H1N1 influenza in 2013–2014. Unlike the pandemic in 2009 clinical course and outcomes associated with critical illness in this postpandemic outbreak has been only sparsely described. Methods: We conducted a retrospective analysis of all patients admitted to the Medical Intensive Care Unit with H1N1 influenza infection in 2009–2010 (pandemic) and 2013–2014 (postpandemic). Results: Patients admitted in the postpandemic period were older (55 ± 13 vs. 45 ± 12, P = 0.002), and had a higher incidence of underlying pulmonary (17 vs. 7, P = 0.0007) and cardiac (16 vs. 8, P = 0.005) disease. Mechanical ventilation was initiated in most patients in both groups (27 vs. 21, P = 1.00). The PaO2/FiO2 ratio was significantly higher in the pandemic group on days 1 (216 vs. 81, P = 0.0009), 3 (202 ± 99 vs. 100 ± 46, P = 0.002) and 7 (199 ± 103 vs. 113 ± 44, P = 0.019) but by day 14 no difference was seen between the groups. Rescue therapies were used in more patients in the postpandemic period (48% vs. 20%, P = 0.028), including more frequent use of prone ventilation (10 vs. 3, P = 0.015), inhaled vasodilator therapy (11 vs. 4, P = 0.015) and extracorporeal membrane oxygenation (ECMO) (4 vs. 2, P = NS). No significant differences in mortality were seen between the two cohorts. Conclusions: Compared to the 2009–2010 pandemic, the 2013–2014 H1N1 strain affected older patients with more underlying co-morbid cardio-pulmonary diseases. The patients had worse oxygenation indices and rescue modalities such as prone ventilation, inhaled epoprostenol and ECMO, were used more consistently as compared to the 2009 pandemic.
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Affiliation(s)
- Jonathan Wiesen
- Department of Pulmonary Critical Care, Cleveland Clinic, Respiratory Institute, Cleveland, Ohio, USA
| | - Dhruv Joshi
- Department of Pulmonary Critical Care, Cleveland Clinic, Respiratory Institute, Cleveland, Ohio, USA
| | - Jorge A Guzman
- Department of Pulmonary Critical Care, Cleveland Clinic, Respiratory Institute, Cleveland, Ohio, USA
| | - Abhijit Duggal
- Department of Pulmonary Critical Care, Cleveland Clinic, Respiratory Institute, Cleveland, Ohio, USA
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13
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Sanchez JL, Cooper MJ, Myers CA, Cummings JF, Vest KG, Russell KL, Sanchez JL, Hiser MJ, Gaydos CA. Respiratory Infections in the U.S. Military: Recent Experience and Control. Clin Microbiol Rev 2015; 28:743-800. [PMID: 26085551 PMCID: PMC4475643 DOI: 10.1128/cmr.00039-14] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
This comprehensive review outlines the impact of military-relevant respiratory infections, with special attention to recruit training environments, influenza pandemics in 1918 to 1919 and 2009 to 2010, and peacetime operations and conflicts in the past 25 years. Outbreaks and epidemiologic investigations of viral and bacterial infections among high-risk groups are presented, including (i) experience by recruits at training centers, (ii) impact on advanced trainees in special settings, (iii) morbidity sustained by shipboard personnel at sea, and (iv) experience of deployed personnel. Utilizing a pathogen-by-pathogen approach, we examine (i) epidemiology, (ii) impact in terms of morbidity and operational readiness, (iii) clinical presentation and outbreak potential, (iv) diagnostic modalities, (v) treatment approaches, and (vi) vaccine and other control measures. We also outline military-specific initiatives in (i) surveillance, (ii) vaccine development and policy, (iii) novel influenza and coronavirus diagnostic test development and surveillance methods, (iv) influenza virus transmission and severity prediction modeling efforts, and (v) evaluation and implementation of nonvaccine, nonpharmacologic interventions.
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Affiliation(s)
- Jose L Sanchez
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Michael J Cooper
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | | | - James F Cummings
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Kelly G Vest
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Kevin L Russell
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Joyce L Sanchez
- Mayo Clinic, Division of General Internal Medicine, Rochester, Minnesota, USA
| | - Michelle J Hiser
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA Oak Ridge Institute for Science and Education, Postgraduate Research Participation Program, U.S. Army Public Health Command, Aberdeen Proving Ground, Aberdeen, Maryland, USA
| | - Charlotte A Gaydos
- International STD, Respiratory, and Biothreat Research Laboratory, Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
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14
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Mosier JM, Hypes C, Joshi R, Whitmore S, Parthasarathy S, Cairns CB. Ventilator Strategies and Rescue Therapies for Management of Acute Respiratory Failure in the Emergency Department. Ann Emerg Med 2015; 66:529-41. [PMID: 26014437 DOI: 10.1016/j.annemergmed.2015.04.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 04/08/2015] [Accepted: 04/20/2015] [Indexed: 01/19/2023]
Abstract
Acute respiratory failure is commonly encountered in the emergency department (ED), and early treatment can have effects on long-term outcome. Noninvasive ventilation is commonly used for patients with respiratory failure and has been demonstrated to improve outcomes in acute exacerbations of chronic obstructive lung disease and congestive heart failure, but should be used carefully, if at all, in the management of asthma, pneumonia, and acute respiratory distress syndrome. Lung-protective tidal volumes should be used for all patients receiving mechanical ventilation, and FiO2 should be reduced after intubation to achieve a goal of less than 60%. For refractory hypoxemia, new rescue therapies have emerged to help improve the oxygenation, and in some cases mortality, and should be considered in ED patients when necessary, as deferring until ICU admission may be deleterious. This review article summarizes the pathophysiology of acute respiratory failure, management options, and rescue therapies including airway pressure release ventilation, continuous neuromuscular blockade, inhaled nitric oxide, and extracorporeal membrane oxygenation.
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Affiliation(s)
- Jarrod M Mosier
- Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona, Tucson, AZ; Department of Emergency Medicine, University of Arizona, Tucson, AZ.
| | - Cameron Hypes
- Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona, Tucson, AZ; Department of Emergency Medicine, University of Arizona, Tucson, AZ
| | - Raj Joshi
- Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona, Tucson, AZ; Department of Emergency Medicine, University of Arizona, Tucson, AZ
| | - Sage Whitmore
- Division of Emergency Critical Care, Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI
| | - Sairam Parthasarathy
- Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona, Tucson, AZ
| | - Charles B Cairns
- Department of Emergency Medicine, University of Arizona, Tucson, AZ
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15
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Cheng Z, Zhou J, To KKW, Chu H, Li C, Wang D, Yang D, Zheng S, Hao K, Bossé Y, Obeidat M, Brandsma CA, Song YQ, Chen Y, Zheng BJ, Li L, Yuen KY. Identification of TMPRSS2 as a Susceptibility Gene for Severe 2009 Pandemic A(H1N1) Influenza and A(H7N9) Influenza. J Infect Dis 2015; 212:1214-21. [PMID: 25904605 PMCID: PMC7107393 DOI: 10.1093/infdis/jiv246] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/27/2015] [Indexed: 01/25/2023] Open
Abstract
The genetic predisposition to severe A(H1N1)2009 (A[H1N1]pdm09) influenza was evaluated in 409 patients, including 162 cases with severe infection and 247 controls with mild infection. We prioritized candidate variants based on the result of a pilot genome-wide association study and a lung expression quantitative trait locus data set. The GG genotype of rs2070788, a higher-expression variant of TMPRSS2, was a risk variant (odds ratio, 2.11; 95% confidence interval, 1.18-3.77; P = .01) to severe A(H1N1)pdm09 influenza. A potentially functional single-nucleotide polymorphism, rs383510, accommodated in a putative regulatory region was identified to tag rs2070788. Luciferase assay results showed the putative regulatory region was a functional element, in which rs383510 regulated TMPRSS2 expression in a genotype-specific manner. Notably, rs2070788 and rs383510 were significantly associated with the susceptibility to A(H7N9) influenza in 102 patients with A(H7N9) influenza and 106 healthy controls. Therefore, we demonstrate that genetic variants with higher TMPRSS2 expression confer higher risk to severe A(H1N1)pdm09 influenza. The same variants also increase susceptibility to human A(H7N9) influenza.
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Affiliation(s)
| | - Jie Zhou
- Department of Microbiology Research Centre of Infection and Immunology State Key Laboratory of Emerging Infectious Diseases
| | - Kelvin Kai-Wang To
- Department of Microbiology Research Centre of Infection and Immunology State Key Laboratory of Emerging Infectious Diseases Carol Yu Centre for Infection
| | - Hin Chu
- Department of Microbiology Research Centre of Infection and Immunology State Key Laboratory of Emerging Infectious Diseases
| | - Cun Li
- Department of Microbiology
| | | | | | - Shufa Zheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, China
| | - Ke Hao
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York
| | - Yohan Bossé
- Department of Molecular Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University
| | - Ma'en Obeidat
- University of British Columbia Center for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada
| | - Corry-Anke Brandsma
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, The Netherlands
| | - You-Qiang Song
- Department of Biochemistry, The University of Hong Kong, Pok Fu Lam
| | - Yu Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, China
| | - Bo-Jian Zheng
- Department of Microbiology Research Centre of Infection and Immunology State Key Laboratory of Emerging Infectious Diseases
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, China
| | - Kwok-Yung Yuen
- Department of Microbiology Research Centre of Infection and Immunology State Key Laboratory of Emerging Infectious Diseases Carol Yu Centre for Infection
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16
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Uyeki TM, Jernigan DB. Response to Al-Husayni and Hassoun. J Clin Virol 2014; 61:176-7. [DOI: 10.1016/j.jcv.2014.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 05/26/2014] [Indexed: 11/24/2022]
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