High mortality in patients with influenza A pH1N1 2009 admitted to a pediatric intensive care unit

• DOI: 10.1097/pcc.0b013e318219266b
• Publication Date: 2011-05-06T08:43:47Z
• Authors: Silvio Fabio Torres; Thomas Iolster; Eduardo Julio Sch...; Julio Alberto Farias; Adriana Claudia B...; Daniel Rufach; María José Montes; Alejandro Javier ...; María Gabriela Ro...; Roberto Jabornisky; Carmen Colman; Analia Fernández; Gustavo Caprotta; Silvia Diaz; Roxana Poterala; Marcela De Meyer; Matías Enrique Pe...; Gustavo González; Silvia Saenz; Oscar Recupero; Luis Zapico; Blanca Alarcon; Esen Ariel; Pablo Minces; Eduardo Mari; Antonio Carnie; Mónica Garea; Roxana Jaen
• Keywords: Male; Models, Statistical; Argentina; Infant; Intensive Care Units, Pediatric; Respiration, Artificial; 3. Good health; 03 medical and health sciences; Influenza A Virus, H1N1 Subtype; Treatment Outcome; 0302 clinical medicine; Risk Factors; Child, Preschool; Influenza, Human; Humans; Female; Hospital Mortality; Retrospective Studies

To describe the clinical characteristics and outcome of patients admitted to pediatric intensive care with influenza A (pH1N1) 2009 in Argentina.Retrospective observational study.Thirteen pediatric intensive care units in Argentina.One hundred and forty-two patients with confirmed or suspected influenza A (H1N1).None.We included 142 critically ill patients. The median age was 19 months (range, 2-110 months) with 39% of the patients <24 months of age. Ninety-nine patients (70%) had an underlying disease. Influenza A (pH1N1) 2009 infection was confirmed in 90 patients and the remaining 52 had a positive direct immunofluorescence assay for influenza A. The median length of stay in the pediatric intensive care unit was 12 days (range, 2-52 days). One hundred eighteen patients (83%) received invasive mechanical ventilation and 19 patients were treated with noninvasive ventilation; however, seven of the patients receiving noninvasive ventilation later needed mechanical ventilation. Sixty-eight patients died (47%) with the most frequent cause refractory hypoxemia. Multivariate logistic regression analysis showed that age <24 months (odds ratio, 2.87; 2.35-3.93), asthma (odds ratio, 1.34; 1.20-2.91), and respiratory coinfection with respiratory syncytial virus (odds ratio, 2.92; 1.20-4.10) were associated with higher mortality. As expected, mechanical ventilation and treatment with inotropes were also associated with increased mortality.The mortality of children admitted to the pediatric intensive care unit with 2009 pH1N1 influenza was high (47%) in our population. Age <24 months, asthma, respiratory coinfection, need of mechanical ventilation, and treatment with inotropes were predictors of poorer outcome.