H1N1 influenza A virus-associated acute lung injury

Response to combination oseltamivir and prolonged corticosteroid treatment

Adolfo Maximo Quispe-Laime, Jonas Daniel Bracco, Patricia Alejandra Barberio, Claudio German Campagne, Verónica Edith Rolfo, Reba Umberger, Gianfranco Meduri

Research output: Contribution to journalArticle

113 Citations (Scopus)

Abstract

Purpose: During the 2009 H1N1 influenza A virus pandemic, a minority of patients developed rapidly progressive pneumonia leading to acute lung injury (ALI)-acute respiratory distress syndrome (ARDS). A recent meta-analysis provides support for prolonged corticosteroid treatment in ALI-ARDS. We prospectively evaluated the response to oseltamivir and prolonged corticosteroid treatment in patients with ALI-ARDS and suspected H1N1 influenza. Methods: From June 24 through 12 July 2009, 13 patients with suspected H1N1 pneumonia and ALI-ARDS were admitted to the intensive care unit (ICU) of a tertiary care hospital. H1N1 influenza was confirmed with real-time reverse transcriptase-polymerase chain reaction assay in eight patients. Oseltamivir and corticosteroid treatment were initiated concomitantly at ICU admission; those with severe ARDS received methylprednisolone (1 mg/kg/day), and others received hydrocortisone (300 mg/day) for a duration of 21 ± 6 days. Results: Patients with and without confirmed H1N1 influenza had similar disease severity at presentation and a comparable response to treatment. By day 7 of treatment, patients experienced a significant improvement in lung injury and multiple organ dysfunction scores (P < 0.001). Twelve patients (92%) improved lung function, were extubated, and discharged alive from the ICU. Hospital length of stay and mortality were 18.7 ± 9.6 days and 15%, respectively. Survivors were discharged home without oxygen supplementation. Conclusions: In ARDS patients, with and without confirmed H1N1 influenza, prolonged low-to-moderate dose corticosteroid treatment was well tolerated and associated with significant improvement in lung injury and multiple organ dysfunction scores and a low hospital mortality. These findings provide the rationale for developing a randomized trial.

Original languageEnglish (US)
Pages (from-to)33-41
Number of pages9
JournalIntensive Care Medicine
Volume36
Issue number1
DOIs
StatePublished - Jan 1 2010

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Oseltamivir
H1N1 Subtype Influenza A Virus
Acute Lung Injury
Influenza A virus
Adult Respiratory Distress Syndrome
Adrenal Cortex Hormones
Human Influenza
Organ Dysfunction Scores
Intensive Care Units
Lung Injury
Therapeutics
Hospital Mortality
Length of Stay
Pneumonia
Severe Acute Respiratory Syndrome
Methylprednisolone
Pandemics
Tertiary Healthcare
Reverse Transcriptase Polymerase Chain Reaction
Tertiary Care Centers

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

H1N1 influenza A virus-associated acute lung injury : Response to combination oseltamivir and prolonged corticosteroid treatment. / Quispe-Laime, Adolfo Maximo; Bracco, Jonas Daniel; Barberio, Patricia Alejandra; Campagne, Claudio German; Rolfo, Verónica Edith; Umberger, Reba; Meduri, Gianfranco.

In: Intensive Care Medicine, Vol. 36, No. 1, 01.01.2010, p. 33-41.

Research output: Contribution to journalArticle

Quispe-Laime, Adolfo Maximo ; Bracco, Jonas Daniel ; Barberio, Patricia Alejandra ; Campagne, Claudio German ; Rolfo, Verónica Edith ; Umberger, Reba ; Meduri, Gianfranco. / H1N1 influenza A virus-associated acute lung injury : Response to combination oseltamivir and prolonged corticosteroid treatment. In: Intensive Care Medicine. 2010 ; Vol. 36, No. 1. pp. 33-41.
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