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Original Research |

Long-term Outcomes of Pandemic 2009 Influenza A(H1N1)-Associated Severe ARDSLong-term Outcomes of 2009 Influenza A(H1N1) ARDS

Charles-Edouard Luyt, MD, PhD; Alain Combes, MD, PhD; Marie-Hélène Becquemin, MD; Catherine Beigelman-Aubry, MD; Stéphane Hatem, MD, PhD; Anne-Laure Brun, MD; Nizar Zraik, MD; Fabrice Carrat, MD, PhD; Philippe A. Grenier, MD; Jean-Christophe M. Richard, MD; Alain Mercat, MD; Laurent Brochard, MD; Christian Brun-Buisson, MD; Jean Chastre, MD for the REVA Study Group
Author and Funding Information

From the Service de Réanimation Médicale (Drs Luyt, Combes and Chastre), Service d’Explorations Fonctionnelles (Drs Becquemin and Zraik), Service de Radiologie (Drs Beigelman-Aubry, Brun, and Grenier), and Service d’explorations fonctionnelles cardio-vasculaires (Dr Hatem), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris et Université Paris 6-Pierre-et-Marie-Curie, Paris France; and Service de Santé Publique, Hôpital Saint-Antoine (Dr Carrat), Assistance Publique-Hôpitaux de Paris, Unité Mixte de Recherche-S 707, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris 6-Pierre-et-Marie-Curie, Paris, France; Service de Réanimation Médicale (Dr Richard), Centre Hospitalier Universitaire de Rouen, Rouen; Service de Réanimation Médicale (Dr Mercat), Centre Hospitalier Universitaire d’Angers, Angers, France; Intensive Care Unit (Dr Brochard), Hôpitaux Universitaires de Genève, Genève, Switzerland; and Service de Réanimation Médicale (Dr Brun-Buisson), Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris 12, Créteil, France.

Correspondence to: Charles-Edouard Luyt, MD, PhD, Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, 47, boulevard de l’Hôpital, 75651 Paris Cedex 13, France; e-mail: charles-edouard.luyt@psl.aphp.fr


For editorial comment see page 583

Members of the REVA Study Group are listed in e-Appendix 1.

Funding/Support: This study was funded by a grant from the INSERM-Institut de Microbiologie et Maladies Infectieuses, France, and French Ministry of Health.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(3):583-592. doi:10.1378/chest.11-2196
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Background:  No data on long-term outcomes of survivors of 2009 influenza A(H1N1) (A[H1N1])-associated ARDS are available. The objective of this study was to compare the 1-year outcomes of survivors of A(H1N1)-associated ARDS, according to use or no use of extracorporeal lung assist (ECLA), using its need as an ARDS severity surrogate.

Methods:  Survivors of ARDS (12 with ECLA use vs 25 without, corresponding to 75% and 54% of the eligible patients for each group, respectively) selected from the Réseau Européen de Ventilation Artificielle (REVA) registry had previously been healthy, with only pregnancy and/or moderate obesity (BMI ≤ 35 kg/m2) as known risk factors for A(H1N1) infection. Lung function and morphology, health-related quality of life (HRQoL), and psychologic impairment were evaluated.

Results:  At 1 year post-ICU discharge for the ECLA and no-ECLA groups, respectively, 50% and 40% reported significant exertion dyspnea, 83% and 64% had returned to work, and 75% and 64% had decreased diffusion capacity across the blood-gas barrier, despite their near-normal and similar lung function test results. For both groups, exercise test results showed diminished but comparable exercise capacities, with similar alveolar-arterial oxygen gradients at peak exercise, and CT scans showed minor abnormal findings. HRQoL assessed by the 36-Item Short-Form Health Survey was poorer for both groups than for a sex- and age-matched general population group, but without between-group differences. ECLA and no-ECLA group patients, respectively, had symptoms of anxiety (50% and 56%) and depression (28% and 28%) and were at risk for posttraumatic stress disorder (41% and 44%).

Conclusions:  One year post-ICU discharge, a majority of survivors of A(H1N1)-associated ARDS had minor lung disabilities with diminished diffusion capacities across the blood-gas barrier, and most had psychologic impairment and poorer HRQoL than a sex- and age-matched general population group. ECLA and no-ECLA group patients had comparable outcomes.

Trial registry:  ClinicalTrials.gov; No.: NCT01271842; URL: www.clinicaltrials.gov

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