• Jordi Rello, Alejandro Rodríguez, Pedro Ibañez, Lorenzo Socias, Javier Cebrian, Asunción Marques, José Guerrero, Sergio Ruiz-Santana, Enrique Marquez, Frutos Del Nogal-Saez, Francisco Alvarez-Lerma, Sergio Martínez, Miquel Ferrer, Manuel Avellanas, Rosa Granada, Enrique Maraví-Poma, Patricia Albert, Rafael Sierra, Loreto Vidaur, Patricia Ortiz, Isidro Prieto del Portillo, Beatriz Galván, Cristóbal León-Gil, and H1N1 SEMICYUC Working Group.
• Critical Care Department, Joan XXIII University Hospital, CIBERes Enfermedades Respiratorias, IISPV, Mallafre Guasch 4, 43007 Tarragona, Spain. jrello.hj23.ics@gencat.cat
• Crit Care. 2009 Jan 1; 13 (5): R148R148.

IntroductionPatients with influenza A (H1N1)v infection have developed rapidly progressive lower respiratory tract disease resulting in respiratory failure. We describe the clinical and epidemiologic characteristics of the first 32 persons reported to be admitted to the intensive care unit (ICU) due to influenza A (H1N1)v infection in Spain.MethodsWe used medical chart reviews to collect data on ICU adult patients reported in a standardized form. Influenza A (H1N1)v infection was confirmed in specimens using real-time reverse transcriptase-polymerase-chain-reaction (RT PCR) assay.ResultsIllness onset of the 32 patients occurred between 23 June and 31 July, 2009. The median age was 36 years (IQR = 31 - 52). Ten (31.2%) were obese, 2 (6.3%) pregnant and 16 (50%) had pre-existing medical complications. Twenty-nine (90.6%) had primary viral pneumonitis, 2 (6.3%) exacerbation of structural respiratory disease and 1 (3.1%) secondary bacterial pneumonia. Twenty-four patients (75.0%) developed multiorgan dysfunction, 7 (21.9%) received renal replacement techniques and 24 (75.0%) required mechanical ventilation. Six patients died within 28 days, with two additional late deaths. Oseltamivir administration delay ranged from 2 to 8 days after illness onset, 31.2% received high-dose (300 mg/day), and treatment duration ranged from 5 to 10 days (mean 8.0 +/- 3.3).ConclusionsOver a 5-week period, influenza A (H1N1)v infection led to ICU admission in 32 adult patients, with frequently observed severe hypoxemia and a relatively high case-fatality rate. Clinicians should be aware of pulmonary complications of influenza A (H1N1)v infection, particularly in pregnant and young obese but previously healthy persons.

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