• Philippe Jouvet, Jamie Hutchison, Ruxandra Pinto, Kusum Menon, Rachel Rodin, Karen Choong, Murray Kesselman, Stasa Veroukis, Marc André Dugas, Miriam Santschi, Anne-Marie Guerguerian, Davinia Withington, Basem Alsaati, Ari R Joffe, Tanya Drews, Peter Skippen, Elizabeth Rolland, Anand Kumar, Robert Fowler, and Canadian Critical Care Trials Group H1N1 Collaborative.
• Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada. philippe.jouvet@umontreal.ca
• Pediatr Crit Care Me. 2010 Sep 1;11(5):603-9.

ObjectiveTo describe characteristics, treatment, and outcomes of critically ill children with influenza A/pandemic influenza A virus (pH1N1) infection in Canada.DesignAn observational study of critically ill children with influenza A/pH1N1 infection in pediatric intensive care units (PICUs).SettingNine Canadian PICUs.PatientsA total of 57 patients admitted to PICUs between April 16, 2009 and August 15, 2009.InterventionsNone.Measurements And Main ResultsCharacteristics of critically ill children with influenza A/pH1N1 infection were recorded. Confirmed intensive care unit cases were compared with a national surveillance database containing all hospitalized pediatric patients with influenza A/pH1N1 infection. Risk factors were assessed with a Cox proportional hazard model. The PICU cohort and national surveillance data were compared, using chi-square tests. Fifty-seven children were admitted to the PICU for community-acquired influenza A/pH1N1 infection. One or more chronic comorbid illnesses were observed in 70.2% of patients, and 24.6% of patients were aboriginal. Mechanical ventilation was used in 68% of children, 20 children (35.1%) had acute lung injury on the first day of admission, and the median duration of ventilation was 6 days (range, 0-67 days). The PICU mortality rate was 7% (4 of 57 patients). When compared with nonintensive care unit hospitalized children, PICU children were more likely to have a chronic medical condition (relative risk, 1.73); aboriginal ethnicity was not a risk factor of intensive care unit admission.ConclusionsDuring the first outbreak of influenza A/pH1N1 infection, when the population was naïve to this novel virus, severe illness was common among children with underlying chronic conditions and aboriginal children. Influenza A/pH1N1-related critical illness in children was associated with severe hypoxemic respiratory failure and prolonged mechanical ventilation. However, this higher rate and severity of respiratory illness did not result in an increased mortality when compared with seasonal influenza.

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