• Natsuko Tokuhira, Nobuaki Shime, Miho Inoue, Tatsuya Kawasaki, Yoshio Sakurai, Norimasa Kurosaka, Ikuya Ueta, Satoshi Nakagawa, and Writing Committee of AH1N1 Investigators; Japanese Society of Intensive Care Medicine Pediatric Intensive Care Unit Network.
• Department of Intensive Care Medicine, Osaka City General Hospital, Osaka, Japan.
• Pediatr Crit Care Me. 2012 Sep 1;13(5):e294-8.

ObjectiveTo outline the characteristics, clinical course, and outcome of pediatric patients requiring mechanical ventilation with influenza A/H1N1 infection in Japan.DesignProspective case registry analysis.SettingEleven pediatric or general intensive care units in Japan.PatientsConsecutive patients infected with A/H1N1, aged from 1 month to 16 yrs old admitted to the intensive care unit for mechanical ventilation between July 2009 and March 2010.InterventionsNone.Measurements And Main ResultsEighty-one children, aged 6.3 [0.8-13.6] (median [interquartile range]) years, were enrolled. Seventy-four (91%) had mechanical ventilation with tracheal intubation. Median duration of mechanical ventilation was 4 days (range 0.04-87) and 18 patients (23%) required mechanical ventilation >7 days. Two patients (2%) required extracorporeal membrane oxygenation. The in-hospital mortality was 1%. Forty-one patients (50%) had at least one underlying chronic condition, including 31 with asthma. Associated clinical symptoms and diagnosis were as follows: acute respiratory distress syndrome (9%), asthma or bronchitis (37%), pneumonia (68%) with 8 (14%) having bacterial pneumonia, neurological symptoms (32%), myocarditis (2%), and rhabdomyolysis (1%). Therapeutic interventions include inotropic support (21%), methylprednisolone therapy (33%), and antimicrobial therapy (88%). Multivariate analysis revealed that inotropic support was the only statistically significant factor associated with mechanical ventilation for more than a week (odds ratio 5.5, 95% confidence interval 1.5-20.5, p = .005).ConclusionsThe clinical presentations of pediatric patients requiring mechanical ventilation for A/H1N1 in Japan were diverse. In-hospital mortality of this population was remarkably low. Rapid access to medical facilities in combination with early administration of antiviral agents may have contributed to the low mortality in this population.

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