Posts Tagged ‘Trabajos Publicados’

Critically ill infants and children with influenza A (H1N1) in pediatric intensive care units in Argentina

utip | 18 Junio 2010 in General | Comentarios (0)

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Julio A. Farias1, Analía Fernández1, Ezequiel Monteverde1, Nilda Vidal2, Pilar Arias3, María J. Montes4, Gabriela Rodríguez5, Mariela Allasia6, Maria E. Ratto7, Roxana Jaén8, Claudia Meregalli9, Karina Fiquepron10, Ana R. Calvo11, Alejandro Siaba12, Lidia Albano2, Rossana Poterala13, Pablo Neira13 and Andrés Esteban14

(1)       Unidad de Cuidados Intensivos Pediátricos, Hospital de Niños R Gutiérrez, Gallo 1330, CABA 1425 Buenos Aires, Argentina
(2)      Unidad de Cuidados Intensivos Pediátricos, Hospital A Posadas, Haedo, Buenos Aires, Argentina
(3)      Unidad de Cuidados Intensivos Pediátricos, Sanatorio Franchin, CABA, Buenos Aires, Argentina
(4)      Unidad de Cuidados Intensivos Pediátricos, Hospital de Niños de la Sma Trinidad, Córdoba, Argentina
(5)      Unidad de Cuidados Intensivos Pediátricos, Hospital F Abete, Buenos Aires, Argentina
(6)      Unidad de Cuidados Intensivos Pediátricos, Hospital de Niños O Allasia, Santa Fe, Argentina
(7)      Unidad de Cuidados Intensivos Pediátricos, Hospital de Niños Sor Ludovica, La Plata, Buenos Aires, Argentina
(8)      Unidad de Cuidados Intensivos Pediátricos, Hospital de Clinicas J de San Martin, CABA, Buenos Aires, Argentina
(9)      Unidad de Cuidados Intensivos Pediátricos, Hospital de Niños P Elizalde, CABA, Buenos Aires, Argentina
(10)      Unidad de Cuidados Intensivos Pediátricos, Hospital El Cruce, Florencio Varela, Buenos Aires, Argentina
(11)      Unidad de Cuidados Intensivos Pediátricos, Hospital del Niño Jesús, San Miguel de Tucumán, Tucumán, Argentina
(12)      Unidad de Cuidados Intensivos Pediátricos, Hospital Austral, Pilar, Buenos Aires, Argentina
(13)      Unidad de Cuidados Intensivos Pediátricos, Sanatorio Anchorena, CABA, Buenos Aires, Argentina
(14)      Unidad de Cuidados Intensivos, Hospital Universitario de Getafe, Madrid, España

Received: 24 October 2009  Accepted: 18 February 2010  Published online: 18 March 2010

Objective

To determine the epidemiological features, course, and outcomes of critically ill pediatric patients with Influenza A (H1N1) virus.
Design

Prospective cohort of children in pediatric intensive care units (PICUs) due to Influenza A (H1N1) virus infection.
Setting

Seventeen medical-surgical PICUs in tertiary care hospital in Argentina.
Patients

All consecutive patients admitted to the PICUs with influenza A (H1N1) viral infection from 15 June to 31 July 2009.
Measurements and main results

Of 437 patients with acute lower respiratory infection in PICUs, 147 (34%) were diagnosed with influenza A (H1N1) related to critical illness. The median age of these patients was 10 months (IQR 3–59). Invasive mechanical ventilation was used in 117 (84%) on admission. The rate of acute respiratory distress syndrome (ARDS) was 80% (118 of 147 patients). Initial non-invasive ventilation failed in 19 of 22 attempts (86%). Mortality at 28 days was 39% (n = 57). Chronic complex conditions (CCCs), acute renal dysfunction (ARD) and ratio PaO2/FiO2 at day 3 on MV were independently associated with a higher risk of mortality. The odds ratio (OR) for CCCs was 3.06, (CI 95% 1.36–6.84); OR for ARD, 3.38, (CI 95% 1.45–10.33); OR for PaO2/FiO2, 4 (CI 95% 1.57–9.59). The administration of oseltamivir within 24 h after admission had a protective effect: OR 0.2 (CI 95% 0.07–0.54).
Conclusions

In children with ARDS, H1N1 as an etiologic agent confers high mortality, and the presence of CCCs in such patients increases the risk of death.

Keywords Critically ill - Influenza A (H1N1) - Infants and children - Mechanical ventilation - Survey

The Mechanical Ventilation in Pediatric Critical Care Group of the Argentine Society of Critical Care Medicine