[Acute respiratory distress syndrome during the 2009 H1N1 influenza A pandemic in Ecuador]

Abstract

Objective: Among the most severe complications caused by the influenza A virus H1N1 pandemic is the Acute Respiratory Distress Syndrome (ARDS). The main objective of this study was to assess mortality after applying a strict protocol of ventilatory management and to describe the clinical characteristics of the patients.

Design: A prospective cohort study.

Setting: Intensive care unit (ICU) of the Hospital Enrique Garcés of the City of Quito.

Patients: Patients admitted to the ICU with a diagnosis of severe pneumonia, ARDS, and high suspicion of influenza A H1N1.

Primary variables of interest: Demographic variables, severity, diagnostic scores of community-acquired pneumonia, ventilator management protocol and mortality at 28 days, as principal effect of the study, were collected.

Results: 24 patients were studied, 100% with a diagnosis of ARDS, mean age 41.1 (+/-14.8). Severe viral pneumonia predominated in these patients, mean APACHE was 18, average PaO(2)/FiO(2) on admission was 74.9, 100% had multisystemic involvement. A total of 91.3% received oseltamivir 150 mg w/12h for 14 days, the mean time between onset of symptoms and antiviral administration was 6.74 days. Intra-ICU mortality was 16.6%, and 28 days was 16.6%.

Conclusions: After applying a strict management protocol for ventilatory management, mortality in this patient group was 16.6. We also stress that obesity and early renal failure were independent risk factors for mortality.