Background and objectives. During the 2009 H1N1 influenza A virus pandemic, a minority of patients developed rapidly progressive pneumonia leading to acute respiratory distress syndrome (ARDS). A recent meta-analysis provides support for prolonged corticosteroid treatment in ARDS. In response to the H1N1 influenza outbreak in Argentina, we developed and prospectively evaluated a protocol for the management of patients with suspected H1N1 influenza and hypoxemic respiratory failure that included combination Oseltamivir and prolonged corticosteroid treatment.
Case control series. Setting: Intensive care unit of a tertiary care hospital in Bahía Blanca, Buenos Aires, Argentina. Thirteen patients with suspected H1N1 influenza and hypoxemic respiratory failure. We collected data on consecutive hospitalized patients. H1N1 influenza was confirmed with real-time reverse-transcriptase poly- merase-chain-reaction assay. Corticosteroid treatment was initiated at ICU admission; those with severe ARDS received methylprednisolone (1 mg/kg/day) and others received hydrocortisone 300 mg/day. Treatment was continued for 2-to-4 weeks.
From June 24 through July 12, 2009, thirteen patients were admitted with suspected H1N1 pneumonia and hypoxemic respiratory failure. Patients with (n = 8) and without (n = 5) confirmed H1N1 influenza had similar disease severity at presentation and comparable response to treatment. By day 7 of treatment, patients experienced a significant improvement in lung injury and multiple organ dysfunction scores (P < 0.001). Twelve patients (92%) improved lung function, were extubated, and discharged alive from the ICU. Hospital length of stay and mortality were 16.4±5.1 days and 15%, respectively. Survivors were discharged home without oxygen supplementation.CONCLUSIONS: In ARDS patients, with and without H1N1 influenza, prolonged low- to-moderate dose corticosteroid treatment was well tolerated and associated with significant improvement in lung injury and multiple organ dysfunction scores and a low hospital mortality.