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Chien SJ, Hsieh YJ, Shih YL, Tseng YJ. Clinical characteristics and outcomes of mixed virus or bacterial infection in children with laboratory-confirmed influenza infection. J Formos Med Assoc 2022; 121:2074-2084. [PMID: 35331620 DOI: 10.1016/j.jfma.2022.03.002] [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: 10/27/2021] [Revised: 02/19/2022] [Accepted: 03/02/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/PURPOSE This study investigated the demographic characteristics and influenza complications of paediatric patients and explored the association of different influenza virus types and viral and bacterial coinfections with disease severity. METHODS This retrospective cohort study used data collected in 2010-2016 from the Chang Gung Research Database (CGRD), the largest collection of multi-institutional electronic medical records in Taiwan. Data were retrieved for children aged 0-18 years with laboratory-confirmed influenza. We extracted and analysed the demographic characteristics and the data on clinical features, complications, microbiological information, and advanced therapies of each case. RESULTS We identified 6193 children with laboratory-confirmed influenza, of whom 1964 (31.7%) were hospitalised. The age of patients with influenza A infection was lower than that of patients with influenza B (4.48 vs. 6.68, p < 0.001). Patients with influenza B infection had a higher incidence of myositis or rhabdomyolysis (4.4%, p < 0.001) and a higher need for advanced therapies (OR, 1.96; 95% CI, 1.32-2.9, p < 0.001). In addition to bacterial (OR, 9.07; 95% CI, 5.29-15.54, p < 0.001) and viral coinfection (OR, 7.73; 95% CI, 5.4-11.07, p < 0.001), dual influenza A and B infection was also a risk factor for influenza complications (OR, 2.13; 95% CI, 1.47-3.09, p < 0.001). CONCLUSION Dual influenza A and B infection and bacterial coinfection can contribute to influenza complications. Early recognition of any influenza complication is critical for the timely initiation of organ-specific advanced therapies to improve influenza-associated outcomes.
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Affiliation(s)
- Shao-Ju Chien
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Kaohsiung, Taiwan; Department of Early Childhood Care and Education, Cheng Shiu University, Kaohsiung, Taiwan
| | - Yun-Jung Hsieh
- Department of Information and Finance Management, National Taipei University of Technology, Taipei, Taiwan; Department of Information Management, Chung Gung University, Taoyuan, Taiwan
| | - Yu-Lien Shih
- Department of Information Management, Chung Gung University, Taoyuan, Taiwan; Department of Nursing, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yi-Ju Tseng
- Department of Computer Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
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MacIntyre CR, Chughtai AA, Barnes M, Ridda I, Seale H, Toms R, Heywood A. The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza a(H1N1)pdm09. BMC Infect Dis 2018; 18:637. [PMID: 30526505 PMCID: PMC6286525 DOI: 10.1186/s12879-018-3548-0] [Citation(s) in RCA: 205] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/23/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The aim of this study was to estimate the prevalence of pneumonia and secondary bacterial infections during the pandemic of influenza A(H1N1)pdm09. METHODS A systematic review was conducted to identify relevant literature in which clinical outcomes of pandemic influenza A(H1N1)pdm09 infection were described. Published studies (between 01/01/2009 and 05/07/2012) describing cases of fatal or hospitalised A(H1N1)pdm09 and including data on bacterial testing or co-infection. RESULTS Seventy five studies met the inclusion criteria. Fatal cases with autopsy specimen testing were reported in 11 studies, in which any co-infection was identified in 23% of cases (Streptococcus pneumoniae 29%). Eleven studies reported bacterial co-infection among hospitalised cases of A(H1N1)2009pdm with confirmed pneumonia, with a mean of 19% positive for bacteria (Streptococcus pneumoniae 54%). Of 16 studies of intensive care unit (ICU) patients, bacterial co-infection identified in a mean of 19% of cases (Streptococcus pneumoniae 26%). The mean prevalence of bacterial co-infection was 12% in studies of hospitalised patients not requiring ICU (Streptococcus pneumoniae 33%) and 16% in studies of paediatric patients hospitalised in general or pediatric intensive care unit (PICU) wards (Streptococcus pneumoniae 16%). CONCLUSION We found that few studies of the 2009 influenza pandemic reported on bacterial complications and testing. Of studies which did report on this, secondary bacterial infection was identified in almost one in four patients, with Streptococcus pneumoniae the most common bacteria identified. Bacterial complications were associated with serious outcomes such as death and admission to intensive care. Prevention and treatment of bacterial secondary infection should be an integral part of pandemic planning, and improved uptake of routine pneumococcal vaccination in adults with an indication may reduce the impact of a pandemic.
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Affiliation(s)
- Chandini Raina MacIntyre
- Biosecurity Program, The Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, NSW 2052 Australia
| | - Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, Faculty of Medicine, UNSW Medicine, the University of New South Wales, Samuels Building, Room 209, Sydney, NSW 2052 Australia
| | - Michelle Barnes
- School of Public Health and Community Medicine, Faculty of Medicine, UNSW Medicine, the University of New South Wales, Samuels Building, Room 209, Sydney, NSW 2052 Australia
| | - Iman Ridda
- School of Public Health and Community Medicine, Faculty of Medicine, UNSW Medicine, the University of New South Wales, Samuels Building, Room 209, Sydney, NSW 2052 Australia
| | - Holly Seale
- School of Public Health and Community Medicine, Faculty of Medicine, UNSW Medicine, the University of New South Wales, Samuels Building, Room 209, Sydney, NSW 2052 Australia
| | - Renin Toms
- School of Public Health and Community Medicine, Faculty of Medicine, UNSW Medicine, the University of New South Wales, Samuels Building, Room 209, Sydney, NSW 2052 Australia
| | - Anita Heywood
- School of Public Health and Community Medicine, Faculty of Medicine, UNSW Medicine, the University of New South Wales, Samuels Building, Room 209, Sydney, NSW 2052 Australia
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Won YK, Hwang TH, Roh EJ, Chung EH. Seasonal Patterns of Asthma in Children and Adolescents Presenting at Emergency Departments in Korea. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2016; 8:223-9. [PMID: 26922932 PMCID: PMC4773210 DOI: 10.4168/aair.2016.8.3.223] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/13/2015] [Accepted: 10/06/2015] [Indexed: 01/10/2023]
Abstract
Purpose Seasonal variations in asthma-related hospitalizations and emergency department visits have long been recognized. This study aimed to investigate the seasonal patterns of asthma in children and adolescents who presented at emergency departments in Korea. Methods We analyzed the National Emergency Department Information System records from 117 emergency departments in Korea that comprised all of the patients with asthma who were aged 3-18 years and who presented at the emergency departments from 2007 to 2012. The children and adolescents were divided into 3 groups based on their ages, namely, 3-6 years, 7-12 years, and 13-18 years. The data were tabulated, and graphs were created to show the seasonal trends in the monthly numbers of emergency department visits as a consequence of asthma. Results A total of 41,128 subjects were identified, and the male-to-female ratio was 1:0.5. General ward admissions comprised 42.6% (n=17,524 patients) of the emergency department visits, and intensive care unit admissions comprised 0.8% (n=335 patients) of the emergency department visits. The monthly numbers of emergency department visits for asthma varied according to the season, with high peaks during fall, which was from September to November, and low levels in summer, which was from June to August. Conclusions Important differences in the seasonal patterns of emergency department visits for asthma were evident in children and adolescents. Identifying seasonal trends in asthma-related emergency department visits may help determine the causes and reduce the likelihood of asthma exacerbation.
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Affiliation(s)
- Youn Kyoung Won
- Department of Pediatrics, National Medical Center, Seoul, Korea
| | - Tae Ho Hwang
- Department of Pediatrics, National Medical Center, Seoul, Korea
| | - Eui Jung Roh
- Department of Pediatrics, Sun General Hospital, Daejeon, Korea
| | - Eun Hee Chung
- Department of Pediatrics, National Medical Center, Seoul, Korea.
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Kim WK. Association between respiratory viruses and asthma exacerbations. KOREAN JOURNAL OF PEDIATRICS 2014; 57:26-8. [PMID: 24578713 PMCID: PMC3935109 DOI: 10.3345/kjp.2014.57.1.26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 11/11/2013] [Indexed: 01/08/2023]
Affiliation(s)
- Woo Kyung Kim
- Department of Pediatrics, Allergy & Respiratory Research Laboratory, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Ruf BR, Knuf M. The burden of seasonal and pandemic influenza in infants and children. Eur J Pediatr 2014; 173:265-76. [PMID: 23661234 PMCID: PMC3930829 DOI: 10.1007/s00431-013-2023-6] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 04/22/2013] [Accepted: 04/23/2013] [Indexed: 12/15/2022]
Abstract
UNLABELLED The burden of influenza is unevenly distributed, with more severe outcomes in children aged <5 years than older children and adults. In spite of this, immunisation policies for young children are far from universal. This article provides an overview of the published evidence on the burden of influenza in children worldwide, with a particular interest in the impact of pandemic influenza in 2009-2010 (caused by the H1N1pdm09 virus). In an average season, up to 9.8 % of 0- to 14-year olds present with influenza, but incidence rates can be markedly higher in younger children. Children aged <5 years have greater rates of hospitalisation and complications than their older counterparts, particularly if the children have co-existing illnesses; historically, this age group have had higher mortality rates from the disease than other children, although during the 2009-2010 pandemic the median age of those who died of influenza was higher than in previous seasons. Admissions to hospital and emergency departments appear to have been more frequent in children with H1N1pdm09 infections than during previous seasonal epidemics, with pneumonia continuing to be a common complication in this setting. Outcomes in children hospitalised with severe disease also seem to have been worse for those infected with H1N1pdm09 viruses compared with seasonal viruses. Studies in children confirm that vaccination reduces the incidence of seasonal influenza and the associated burden, underlining the importance of targeting this group in national immunisation policies. CONCLUSIONS Children aged <5 years are especially vulnerable to influenza, particularly that caused by seasonal viruses, and vaccination in this group can be an effective strategy for reducing disease burden.
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Affiliation(s)
- Bernhard R. Ruf
- Division of Infectious Diseases and Tropical Medicine, Klinikum Sankt Georg Leipzig, Leipzig, Germany
| | - Markus Knuf
- Klinik für Kinder und Jugendliche, Dr. Horst Schmidt Klinik, Ludwig-Erhard-Str. 100, 65199 Wiesbaden, Germany ,University Medicine, Pediatric Infectious Diseases, Mainz, Germany
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A review of the evidence to support influenza vaccine introduction in countries and areas of WHO's Western Pacific Region. PLoS One 2013; 8:e70003. [PMID: 23875015 PMCID: PMC3713047 DOI: 10.1371/journal.pone.0070003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/17/2013] [Indexed: 11/24/2022] Open
Abstract
Background Immunization against influenza is considered an essential public health intervention to control both seasonal epidemics and pandemic influenza. According to the World Health Organization (WHO), there are five key policy and three key programmatic issues that decision-makers should consider before introducing a vaccine. These are (a) public health priority, (b) disease burden, (c) efficacy, quality and safety of the vaccine, (d) other inventions, (e) economic and financial issues, (f) vaccine presentation, (g) supply availability and (h) programmatic strength. We analyzed the body of evidence currently available on these eight issues in the WHO Western Pacific Region. Methodology/Principal Findings Studies indexed in PubMed and published in English between 1 January 2000 and 31 December 2010 from the 37 countries and areas of the Western Pacific Region were screened for keywords pertaining to the five policy and three programmatic issues. Studies were grouped according to country income level and vaccine target group. There were 133 articles that met the selection criteria, with most (90%) coming from high-income countries. Disease burden (n = 34), vaccine efficacy, quality and safety (n = 27) and public health priority (n = 27) were most frequently addressed by studies conducted in the Region. Many studies assessed influenza vaccine policy and programmatic issues in the general population (42%), in the elderly (24%) and in children (17%). Few studies (2%) addressed the eight issues relating to pregnant women. Conclusions/Significance The evidence for vaccine introduction in countries and areas in this Region remains limited, particularly in low- and middle-income countries that do not currently have influenza vaccination programmes. Surveillance activities and specialized studies can be used to assess the eight issues including disease burden among vaccine target groups and the cost-effectiveness of influenza vaccine. Multi-country studies should be considered to maximize resource utilization for cross-cutting issues such as vaccine presentation and other inventions.
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Autism-specific maternal autoantibodies recognize critical proteins in developing brain. Transl Psychiatry 2013; 3:e277. [PMID: 23838888 PMCID: PMC3731784 DOI: 10.1038/tp.2013.50] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 04/22/2013] [Accepted: 04/23/2013] [Indexed: 11/16/2022] Open
Abstract
Autism spectrum disorders (ASDs) are neurodevelopmental in origin, affecting an estimated 1 in 88 children in the United States. We previously described ASD-specific maternal autoantibodies that recognize fetal brain antigens. Herein, we demonstrate that lactate dehydrogenase A and B (LDH), cypin, stress-induced phosphoprotein 1 (STIP1), collapsin response mediator proteins 1 and 2 (CRMP1, CRMP2) and Y-box-binding protein to comprise the seven primary antigens of maternal autoantibody-related (MAR) autism. Exclusive reactivity to specific antigen combinations was noted in 23% of mothers of ASD children and only 1% of controls. ASD children from mothers with specific reactivity to LDH, STIP1 and CRMP1 and/or cypin (7% vs 0% in controls; P<0.0002; odds ratios of 24.2 (95% confidence interval: 1.45-405)) had elevated stereotypical behaviors compared with ASD children from mothers lacking these antibodies. We describe the first panel of clinically significant biomarkers with over 99% specificity for autism risk thereby advancing our understanding of the etiologic mechanisms and therapeutic possibilities for MAR autism.
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Myocarditis Associated with Influenza A H1N1pdm2009. INFLUENZA RESEARCH AND TREATMENT 2012; 2012:351979. [PMID: 23304476 PMCID: PMC3533457 DOI: 10.1155/2012/351979] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 10/28/2012] [Accepted: 11/15/2012] [Indexed: 11/19/2022]
Abstract
Acute myocarditis is a well-known complication of influenza infection. The frequency of myocardial involvement in influenza infection varies widely, with the clinical severity ranging from asymptomatic to fulminant varieties. The worst cases can result in death due to impaired cardiac function, although such fulminant myocarditis associated with influenza infection is rare, as shown by previous papers. Following the 2009 influenza pandemic, we reported on the clinical features of a cohort of 15 patients in Japan with H1N1pdm2009 myocarditis. In our subsequent survey of the literature for case reports or series of patients with myocarditis associated with H1N1pdm2009, we identified 58 detailed cases. We discuss here the high prevalence of fulminant myocarditis (36/58, 62%) among patients reported to have myocarditis associated with H1N1pdm2009. Mechanical circulatory support was required in 17 of the patients with fulminant myocarditis, 13 of whom recovered. We stress the need for increased awareness of influenza-associated myocarditis; such knowledge will facilitate earlier diagnosis and treatment of this fatal complication during future influenza pandemics.
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Post-marketing assessment of neuropsychiatric adverse events in influenza patients treated with oseltamivir: an updated review. Adv Ther 2012; 29:826-48. [PMID: 23054689 DOI: 10.1007/s12325-012-0050-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Indexed: 10/27/2022]
Abstract
A 2008 review by our group concluded that the risk of neuropsychiatric adverse events (NPAEs) in influenza patients was not increased by oseltamivir exposure, and did not identify any mechanism by which oseltamivir or its metabolites could cause or worsen such events. The current article reviews new information on this topic. Between September 16, 2007 and May 15, 2010, 1,805 spontaneously-reported NPAEs were identified in 1,330 patients receiving oseltamivir: 767 (42.5%) from Japan, 296 (16.4%) from the USA, and 742 (41.1%) from other countries. NPAEs were more common in children: 1,072 (59.4%) events were in those aged ≤16 years. NPAEs often occurred within 48 h of treatment initiation (953 events; 52.8%). Nearly half of the events were serious in nature (838; 46.4%). The three largest categories of events were abnormal behavior (457 events, 25.3%), miscellaneous psychiatric events (370; 20.5%), and delusions/perceptual disturbances (316 events, 17.5%). A total of 1,545 events (85.6%) in eight different categories were considered to be delirium or delirium-like. Twenty-eight suicide-related events were reported. A US healthcare claims database analysis showed that the risk of NPAEs in 7,798 oseltamivir-treated patients was no higher than that in 10,411 patients not on antivirals, but a study on oseltamivir and abnormal behavior in Japan was less conclusive. NPAE frequency in oseltamivir-exposed Japanese and Taiwanese children with influenza was the same as in unexposed children. New analysis of the UK General Practice Research Database showed that the relative adjusted risk of NPAEs in influenza patients was 2.18-times higher than in the general population. Other epidemiology studies report frequent occurrence of encephalitis and similar disorders in influenza patients independently of oseltamivir exposure. The new data support the findings of the original assessment. Evidence suggests that influenza-related encephalopathies are caused by influenza-induced inflammatory responses, but more work is needed to confirm the underlying mechanisms.
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A review on the clinical spectrum and natural history of human influenza. Int J Infect Dis 2012; 16:e714-23. [DOI: 10.1016/j.ijid.2012.05.1025] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 05/14/2012] [Indexed: 01/27/2023] Open
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Kim S, Cho HJ, Han DK, Choi YD, Yang ES, Cho YK, Ma JS. Recurrent plastic bronchitis in a child with 2009 influenza A (H1N1) and influenza B virus infection. J Korean Med Sci 2012; 27:1114-9. [PMID: 22969262 PMCID: PMC3429833 DOI: 10.3346/jkms.2012.27.9.1114] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 05/28/2012] [Indexed: 11/20/2022] Open
Abstract
Plastic bronchitis is an uncommon disorder characterized by the formation of bronchial casts. It is associated with congenital heart disease or pulmonary disease. In children with underlying conditions such as allergy or asthma, influenza can cause severe plastic bronchitis resulting in respiratory failure. A review of the literature showed nine cases of plastic bronchitis with H1N1 including this case. We report a case of a child with recurrent plastic bronchitis with eosinophilic cast associated with influenza B infection, who had recovered from plastic bronchitis associated with an influenza A (H1N1) virus infection 5 months previously. To the best of our knowledge, this is the first case of recurrent plastic bronchitis related to influenza viral infection. If patients with influenza virus infection manifest acute respiratory distress with total lung atelectasis, clinicians should consider plastic bronchitis and early bronchoscopy should be intervened. In addition, management for underlying disease may prevent from recurrence of plastic bronchitis.
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Affiliation(s)
- Sun Kim
- Department of Family Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Hwa Jin Cho
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Dong Kyun Han
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Yoo Duk Choi
- Department of Pathology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Eun Seok Yang
- Department of Pediatrics, Chosun University College of Medicine, Gwangju, Korea
| | - Young Kuk Cho
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Jae Sook Ma
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
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Epidemiological analysis of critically ill adult patients with pandemic influenza A(H1N1) in South Korea. Epidemiol Infect 2012; 141:1070-9. [PMID: 22853817 DOI: 10.1017/s0950268812001604] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A total of 245 patients with confirmed 2009 H1N1 influenza were admitted to the intensive-care units of 28 hospitals (South Korea). Their mean age was 55.3 years with 68.6% aged >50 years, and 54.7% male. Nine were obese and three were pregnant. One or more comorbidities were present in 83.7%, and nosocomial acquisition occurred in 14.3%. In total, 107 (43.7%) patients received corticosteroids and 66.1% required mechanical ventilation. Eighty (32.7%) patients died within 30 days after onset of symptoms and 99 (40.4%) within 90 days. Multivariate logistic regression analysis showed that the clinician's decision to prescribe corticosteroids, older age, Sequential Organ Failure Assessment score and nosocomial bacterial pneumonia were independent risk factors for 90-day mortality. In contrast with Western countries, critical illness in Korea in relation to 2009 H1N1 was most common in older patients with chronic comorbidities; nosocomial acquisition occurred occasionally but disease in obese or pregnant patients was uncommon.
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Kim YN, Cho HJ, Cho YK, Ma JS. Clinical significance of pleural effusion in the new influenza A (H1N1) viral pneumonia in children and adolescent. Pediatr Pulmonol 2012; 47:505-9. [PMID: 22028096 DOI: 10.1002/ppul.21588] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 09/17/2011] [Indexed: 12/30/2022]
Abstract
BACKGROUND Parapneumonic effusion has been reported to develop either in typical bacterial infection or in viral pneumonia with bacterial co-infection and to cause death. Swine-origin influenza A (H1N1) virus infection can be accompanied with pleural effusion; however, there are no reports about the significance of pleural effusion in H1N1 pneumonia. We retrospectively analyzed both the clinical characteristics and the significance of pleural effusion associated with H1N1 pneumonia in children and adolescent. METHOD Eighty-nine patients who were admitted with H1N1 pneumonia were divided into two groups: 17 patients with pleural effusion (i.e., the effusion group), and 72 patients without pleural effusion (the non-effusion group). RESULTS Lymphopenia (P = 0.030), elevation of the C-reactive protein (P = 0.026), and positive rate of anti-sptreptolysin O titer (P = 0.040) were significantly increased in the effusion group than in the non-effusion group. In addition, the need for treatment with both oxygen (P < 0.001) and oseltamivir (P = 0.013) was significantly increased in the effusion group. However, there was no significant difference between the two investigated groups in the duration of the treatment with intravenous antibiotics, the time of fever remission calculated from admission, and the days of hospital stay. Also, there was no documented bacterial co-infection in any of the studied groups. CONCLUSION This result suggested that pleural effusion in H1N1 pneumonia could develop without bacterial co-infection and had mild clinical course.
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Affiliation(s)
- Young Nam Kim
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea
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Kang SH, Choi HM, Lee EH. Positive rates of 2009 novel influenza A (H1N1) was high in school-aged individuals: significance in pandemic control. J Korean Med Sci 2012; 27:332-4. [PMID: 22379349 PMCID: PMC3286785 DOI: 10.3346/jkms.2012.27.3.332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 01/02/2012] [Indexed: 11/20/2022] Open
Abstract
In this study, data from a pandemic H1N1 outbreak in Korea were analyzed according to time, geography (districts), and age. A total of 252,271 samples collected nationwide were referred to the Greencross Reference Laboratory from June 2009 to February 2010 for H1N1 confirmation testing. Of these samples, 105,300 (41.7%) were H1N1-positive. With time, positivity was highest (57.0%) from October 26 - November 1 (4 weeks after Chuseok). The positive rates among districts show the highest value in Ulsan City (63.1%) and the lowest in Gyeongnam Province (32.8%). The positive rates for ages 0-2, 3-5, 6-11, 12-17, 18-20, 21-30, 31-40, 41-50, 51-60, and > 60 yr were 17.0%, 33.1%, 56.2%, 55.5%, 55.3%, 41.5%, 28.2%, 30.5%, 31.1%, and 16.8%, respectively, indirectly indicating propagation of H1N1 through schools. Pandemic control should involve school-targeted strategies.
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Randolph AG, Vaughn F, Sullivan R, Rubinson L, Thompson BT, Yoon G, Smoot E, Rice TW, Loftis LL, Helfaer M, Doctor A, Paden M, Flori H, Babbitt C, Graciano AL, Gedeit R, Sanders RC, Giuliano JS, Zimmerman J, Uyeki TM. Critically ill children during the 2009-2010 influenza pandemic in the United States. Pediatrics 2011; 128:e1450-8. [PMID: 22065262 PMCID: PMC3387899 DOI: 10.1542/peds.2011-0774] [Citation(s) in RCA: 181] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The 2009 pandemic influenza A (H1N1) (pH1N1) virus continues to circulate worldwide. Determining the roles of chronic conditions and bacterial coinfection in mortality is difficult because of the limited data for children with pH1N1-related critical illness. METHODS We identified children (<21 years old) with confirmed or probable pH1N1 admitted to 35 US PICUs from April 15, 2009, through April 15, 2010. We collected data on demographics, baseline health, laboratory results, treatments, and outcomes. RESULTS Of 838 children with pH1N1 admitted to a PICU, the median age was 6 years, 58% were male, 70% had ≥1 chronic health condition, and 88.2% received oseltamivir (5.8% started before PICU admission). Most patients had respiratory failure with 564 (67.3%) receiving mechanical ventilation; 162 (19.3%) received vasopressors, and 75 (8.9%) died. Overall, 71 (8.5%) of the patients had a presumed diagnosis of early (within 72 hours after PICU admission) Staphylococcus aureus coinfection of the lung with 48% methicillin-resistant S aureus (MRSA). In multivariable analyses, preexisting neurologic conditions or immunosuppression, encephalitis (1.7% of cases), myocarditis (1.4% of cases), early presumed MRSA lung coinfection, and female gender were mortality risk factors. Among 251 previously healthy children, only early presumed MRSA coinfection of the lung (relative risk: 8 [95% confidence interval: 3.1-20.6]; P < .0001) remained a mortality risk factor. CONCLUSIONS Children with preexisting neurologic conditions and immune compromise were at increased risk of pH1N1-associated death after PICU admission. Secondary complications of pH1N1, including myocarditis, encephalitis, and clinical diagnosis of early presumed MRSA coinfection of the lung, were mortality risk factors.
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Affiliation(s)
- Adrienne G. Randolph
- Department of Anesthesia, Perioperative and Pain Medicine, Children's Hospital Boston, Boston, Massachusetts; ,Harvard Medical School, Boston, Massachusetts
| | - Frances Vaughn
- National Disaster Medical System, Office of Preparedness and Emergency Operations, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
| | - Ryan Sullivan
- Department of Anesthesia, Perioperative and Pain Medicine, Children's Hospital Boston, Boston, Massachusetts
| | - Lewis Rubinson
- National Disaster Medical System, Office of Preparedness and Emergency Operations, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
| | - B. Taylor Thompson
- ARDSNet Coordinating Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Grace Yoon
- Department of Anesthesia, Perioperative and Pain Medicine, Children's Hospital Boston, Boston, Massachusetts
| | - Elizabeth Smoot
- ARDSNet Coordinating Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Todd W. Rice
- Department of Medicine, Vanderbilt University School of Medicine, Vanderbilt, Tennessee
| | - Laura L. Loftis
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Mark Helfaer
- Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Allan Doctor
- Department of Pediatrics, St Louis Children's Hospital, St Louis, Missouri
| | - Matthew Paden
- Department of Pediatrics, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia
| | - Heidi Flori
- Department of Pediatrics, Children's Hospital Oakland, Oakland, California
| | - Christopher Babbitt
- Department of Pediatrics, Miller Children's Hospital, Long Beach, California
| | - Ana Lia Graciano
- Department of Pediatrics, Children's Hospital of Central California, Madera, California
| | - Rainer Gedeit
- Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Ronald C. Sanders
- Department of Pediatrics, Arkansas Children's Hospital, Little Rock, Arkansas
| | - John S. Giuliano
- Department of Pediatrics, Yale Children's Hospital, New Haven, Connecticut
| | - Jerry Zimmerman
- Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, Washington; and
| | - Timothy M. Uyeki
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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16
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Yeom JS, Park JS, Seo JH, Park ES, Lim JY, Park CH, Woo HO, Youn HS, Cho JM. Factors associated with hypoxemia in children infected with pandemic H1N1 2009 influenza virus. Pediatr Int 2011; 53:622-625. [PMID: 21199168 DOI: 10.1111/j.1442-200x.2010.03319.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hypoxemia was found to be a major cause of death from pandemic H1N1 2009 influenza (pH1N1) infection. There are limited data on factors associated with hypoxemia in children infected with pH1N1 influenza virus. METHODS Factors associated with hypoxemia were investigated using univariate and multivariate analysis in 76 hospitalized pediatric patients with laboratory-confirmed H1N1 influenza virus infection at Gyeongsang National University Hospital in Jinju, South Korea, from August 2009 to January 2010 by retrospective chart review. RESULTS Hypoxemia occurred in 17 children (22%), of whom three were admitted to an intensive care unit and one died. Hypoxemic patients were significantly more likely to have a higher respiratory rate, pulse rate, white blood cell count (WBC), and C-reactive protein level, as well as a longer hospital stay. Respiratory rate and WBC count at admission were independently associated with hypoxemia as determined on multivariate analysis, and this association was found to be clinically significant. CONCLUSION Although a higher WBC count and respiratory rate may not be specific for pHINI but represent the degree of disease severity for any infectious respiratory disease in general, clinicians can use these parameters at admission as useful, early indicators of disease severity in pediatric pH1N1 infection.
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Affiliation(s)
- Jung Sook Yeom
- Departments of PediatricsRadiology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ji Sook Park
- Departments of PediatricsRadiology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ji-Hyun Seo
- Departments of PediatricsRadiology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Eun Sil Park
- Departments of PediatricsRadiology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jae-Young Lim
- Departments of PediatricsRadiology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chan-Hoo Park
- Departments of PediatricsRadiology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hyang-Ok Woo
- Departments of PediatricsRadiology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hee-Shang Youn
- Departments of PediatricsRadiology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jae Min Cho
- Departments of PediatricsRadiology, Gyeongsang National University School of Medicine, Jinju, Korea
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17
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Lee E, Seo JH, Kim HY, Na S, Kim SH, Kwon JW, Kim BJ, Hong SJ. Clinical characteristics and outcomes among pediatric patients hospitalized with pandemic influenza A/H1N1 2009 infection. KOREAN JOURNAL OF PEDIATRICS 2011; 54:329-34. [PMID: 22087199 PMCID: PMC3212702 DOI: 10.3345/kjp.2011.54.8.329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 05/26/2011] [Accepted: 06/13/2011] [Indexed: 11/27/2022]
Abstract
Purpose The purpose of this article is to describe the clinical and epidemiologic features and outcomes among children hospitalized with pandemic influenza A/H1N1 2009 infection. Methods We retrospectively reviewed the charts of hospitalized pediatric patients (<18 years) diagnosed with pandemic influenza A/H1N1 2009 infection by reverse-transcriptase polymerase chain reaction at a tertiary hospital in Seoul, Korea, between September 2009 and February 2010. Results A total of 72 children were hospitalized with pandemic influenza A/H1N1 2009 infection (median age, 6.0 years; range, 2 months to 18 years). A total of 40% had at least 1 underlying medical condition, including asthma (17%), malignancies (19%), and heart diseases (17%). Of the 72 patients, 54 (76%) children admitted with H1N1 infection showed radiographic alterations compatible with pneumonia. There was no significant difference in pre-existing conditions between pandemic influenza A/H1N1 infected patients with or without pneumonia. Children with pandemic influenza A/H1N1 pneumonia were more likely to have a lower lymphocyte ratio (P=0.02), higher platelet count (P=0.02), and higher level of serum glucose (P=0.003), and more commonly presented with dyspnea than did those without pneumonia (P=0.04). Conclusion No significant differences in age, sex, or presence of preexisting conditions were found between children hospitalized with pandemic influenza A/H1N1 H1N1 influenza infection with pneumonia and those without pneumonia. Higher leukocyte count, higher glucose level, and a lower lymphocyte ratio were associated with the development of pandemic A/H1N1 2009 influenza pneumonia.
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Affiliation(s)
- Eun Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, Seoul, Korea
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18
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Chiu SS, Chan KH, Wong WHS, Chan ELY, Peiris JSM. Age-matched comparison of children hospitalized for 2009 pandemic H1N1 influenza with those hospitalized for seasonal H1N1 and H3N2. PLoS One 2011; 6:e21837. [PMID: 21799750 PMCID: PMC3140491 DOI: 10.1371/journal.pone.0021837] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 06/13/2011] [Indexed: 11/30/2022] Open
Abstract
Background A wide spectrum of clinical manifestation ranging from deaths to a mild course of disease has been reported in children infected with the 2009 pandemic H1N1 (pH1N1) influenza. Methodology/Major Findings We conducted an age-matched control study comparing children hospitalized for pH1N1 with historic controls infected with seasonal H1N1 and H3N2 influenza to correct for the effect of age on disease susceptibility and clinical manifestations. We also compared children with pH1N1 to children concurrently admitted for seasonal influenza during the pandemic period to adjust for differences in health-seeking behavior during the pandemic or other potential bias associated with historic controls. There was no death or intensive care admission. Children with pH1N1 were more likely to have at least one risk condition for influenza, an underlying chronic pulmonary condition, more likely to have asthma exacerbation and to be treated with oseltamivir. There was no difference in other aspects of the clinical course or outcome. Conclusion Disease manifestation of children hospitalized for pH1N1 infection was mild in our patient population.
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Affiliation(s)
- Susan S Chiu
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
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19
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Das RR. Bacterial co-infection, antiviral therapy, and prevention of spread of H1N1 infection. Pediatr Pulmonol 2011; 46:621-2; author reply 623-4. [PMID: 21246760 DOI: 10.1002/ppul.21412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Kang SJ, Lee JM, Hah JO, Shim YJ, Lee KS, Shin HJ, Kim HS, Choi EJ, Jeon SE, Lim YT, Park JK, Park ES. Novel influenza A (H1N1) 2009 infection in the pediatric patients with hematologic and oncologic diseases in the Yeungnam region. KOREAN JOURNAL OF PEDIATRICS 2011; 54:117-22. [PMID: 21738541 PMCID: PMC3120997 DOI: 10.3345/kjp.2011.54.3.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 11/10/2010] [Accepted: 12/21/2010] [Indexed: 12/01/2022]
Abstract
Purpose Natural history and consequences of the novel 2009 influenza A H1N1 (2009 H1N1) infection in immunocompromised pediatric patients are not yet fully understood. In this study, we investigated the clinical features and outcomes of the 2009 H1N1 infection in pediatric patients with hematological and oncological diseases. Methods We retrospectively reviewed the medical records of 528 patients who had hematological and oncological diseases and who were treated at 7 referral centers located in the Yeungnam region. Among the 528 patients, 27 with definite diagnosis of 2009 H1N1 infection were the subjects of this study. All patients were divided into the following 3 groups: patients who were receiving chemotherapy (group 1), patients who were immunosuppressed due to a non-malignant hematological disease (group 2), and patients who were off chemotherapy and had undergone their last chemotherapy course within 2 years from the influenza A pandemic (group 3). Results All 28 episodes of 2009 H1N1 infection were treated with the antiviral agent oseltamivir (Tamiflu®), and 20 episodes were treated after hospitalization. Group 1 patients had higher frequencies of lower respiratory tract infection and longer durations of fever and hospitalization as compared to those in group 2. Ultimately, all episodes resolved completely with no complications. Conclusion These results suggest that early antiviral therapy did not influence the morbidity or mortality of pediatric patients with hematological and oncological diseases in the Yeungnam region of Korea after the 2009 H1N1 infection. However, no definite conclusions can be drawn because of the small sample size.
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Affiliation(s)
- Seok Jeong Kang
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu, Korea
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Kang SJ, Lee JM, Hah JO, Shim YJ, Lee KS, Shin HJ, Kim HS, Choi EJ, Jeon SE, Lim YT, Park JK, Park ES. Novel influenza A (H1N1) 2009 infection in the pediatric patients with hematologic and oncologic diseases in the Yeungnam region. KOREAN JOURNAL OF PEDIATRICS 2011. [DOI: 10.3345/kjp.2011.54.3.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Seok Jeong Kang
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jae Min Lee
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jeong Ok Hah
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu, Korea
| | - Ye Jee Shim
- Department of Pediatrics, College of Medicine, Kyungbook National University, Daegu, Korea
| | - Kun Soo Lee
- Department of Pediatrics, College of Medicine, Kyungbook National University, Daegu, Korea
| | - Hyun Jung Shin
- Department of Pediatrics, College of Medicine, Keimyung University, Daegu, Korea
| | - Heung Sik Kim
- Department of Pediatrics, College of Medicine, Keimyung University, Daegu, Korea
| | - Eun Jin Choi
- Department of Pediatrics, College of Medicine, Daegu Catholic University, Daegu, Korea
| | - So Eun Jeon
- Department of Pediatrics, College of Medicine, Pusan National University, Busan, Korea
| | - Young Tak Lim
- Department of Pediatrics, College of Medicine, Pusan National University, Busan, Korea
| | - Ji Kyeong Park
- Department of Pediatrics, College of Medicine, Inje university, Busan, Korea
| | - Eun Sil Park
- Department of Pediatrics, College of Medicine, Gyeongsang National University, Jinju, Korea
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22
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The relationship between extravascular lung water and oxygenation in three patients with influenza A (H1N1)-induced respiratory failure. Wien Klin Wochenschr 2010; 122:637-40. [PMID: 20949325 PMCID: PMC7102316 DOI: 10.1007/s00508-010-1475-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 10/02/2010] [Indexed: 11/10/2022]
Abstract
This case series reports the correlation between extravascular lung water (EVLW) and the partial arterial oxygen pressure/fractional inspiratory oxygen (PaO2/FiO2) ratio in three patients with severe influenza A (H1N1)-induced respiratory failure. All patients suffered from grave hypoxia (PaO2, 26–42 mmHg) and were mechanically ventilated using biphasic airway pressure (PEEP, 12–15 mmHg; FiO2, 0.8–1) in combination with prone positioning at 12 hourly intervals. All patients were monitored using the PICCO® system for 8–11 days. During mechanical ventilation, a total of 62 simultaneous determinations of the PaO2/FiO2 ratio and EVLW were performed. A significant correlation between EVLW and the PaO2/FiO2 ratio (Spearman-rho correlation coefficient, –0.852; p < 0.001) was observed. In all patients, a decrease in EVLW was accompanied by an improvement in oxygenation. Serum lactate dehydrogenase levels were elevated in all patients and significantly correlated with EVLW during the intensive care unit stay (Spearman-rho correlation coefficient, 0.786; p < 0.001). In conclusion, EVLW seems increased in patients with severe H1N1-induced respiratory failure and appears to be closely correlated with impairments of oxygenatory function.
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