• J Marin-Corral, C Climent, R Muñoz, M Samper, I Dot, C Vilà, J R Masclans, A Rodriguez, I Martin-Loeches, F Álvarez-Lerma, and en representacion del Grupo de Trabajo H1N1 GETGAG SEMICYUC.
• Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Grupo de Investigación en Patología Crítica (GREPAC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España. Electronic address: jmarincorral@gmail.com.
• Med Intensiva. 2018 Nov 1; 42 (8): 473-481.

ObjectivesTo evaluate the impact of the recommendations of the SEMICYUC (2012) on severe influenza A.DesignA prospective multicenter observational study was carried out.SettingICU.PatientsPatients infected with severe influenza A (H1N1) from the GETGAG/SEMICYUC registry.InterventionsAnalysis of 2 groups according to the epidemic period of the diagnosis (2009-2011; 2013-2015).VariablesDemographic, temporal, comorbidities, severity, treatments, mortality, late diagnosis and place of acquisition.ResultsA total of 2,205 patients were included, 1,337 (60.6%) in the first period and 868 (39.4%) in the second one. Age and severity on admission were significantly greater in the second period, as well as co-infection. With regard to the impact of the recommendations, in the second period the diagnosis was established earlier (70.8 vs. 61.1%, P<.001), without changes in the start of treatment. Patients received less corticosteroid treatment (39.7 vs. 44.9%, P<.05), more NIMV was used (47.4 vs. 33.2%, P<.001) and more vaccination was made (11.1 vs. 1.7%, P<.001), without changes in mortality (24.2 vs. 20.7%). A decrease in nosocomial infection was also noted (9.8 vs. 16%, P<.001). Patients needed less MV with more days of ventilation, more vasopressor drug use and more ventral decubitus.ConclusionsThe management of patients with severe influenza A (H1N1) has changed over the years, though without changes in mortality. The recommendations of the SEMICYUC (2012) have allowed earlier diagnosis and improved corticosteroid use. Pending challenges are the delay in treatment, the vaccination rate and the use of NIMV.Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

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