Acute Respiratory Distress Syndrome as a presenting manifestation in young patients infected with H1N1 influenza virus

Dirk Pabst, Joachim Kuehn, Susanne Schuler-Luettmann, Karsten Wiebe, Pia Lebiedz

Research output: Contribution to journalArticle

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Abstract

Introduction: The new strain of influenza A (H1N1) 2009, often referred to colloquially as "swine flu", which was first detected in April 2009, raised to a pandemic of which the impact was not completely predictable. As reported, numerous cases with severe respiratory failure were also seen among young previously healthy people. Patients: In the present study, we report eight cases of influenza A (H1N1) 2009 admitted to our medical intensive care with severe respiratory failure between November and December 2009 and in January 2011. All patients were older than 30 but younger than 50 years, had clinical and radiological evidence of an Acute Respiratory Distress Syndrome (ARDS) and needed invasive ventilatory support. Results: Six of the eight patients had no relevant underlying disease; one had a pre-existing idiopathic lung fibrosis and another had a chronic obstructive pulmonary disease (COPD), an abuse of alcohol and an adiposities grade 3. Four patients needed an extracorporeal membrane oxygenation (ECMO) due to severe respiratory failure with global respiratory insufficiency that could not be treated by conservative ventilatory support. The one patient with a pre-existing lung fibrosis died shortly after lung transplantation despite use of an extracorporeal membrane oxygenation. One other patient died due to a subarachnoidal bleeding under the anticoagulatory regime during ECMO therapy. The adipose COPD-patient died due to septic shock with multiple organ failure without possibility for ECMO support. Conclusions: The clinical course of severe cases of influenza A (H1N1) 2009-infection is markedly different from the disease pattern seen during epidemics of seasonal influenza. Most of the patients admitted to our intensive care unit due to influenza A (H1N1) 2009 associated ARDS were previously healthy young people.

Original languageEnglish (US)
JournalEuropean Journal of Internal Medicine
Volume22
Issue number6
DOIs
StatePublished - Dec 1 2011

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H1N1 Subtype Influenza A Virus
Adult Respiratory Distress Syndrome
Orthomyxoviridae
Extracorporeal Membrane Oxygenation
Human Influenza
Respiratory Insufficiency
Chronic Obstructive Pulmonary Disease
Fibrosis
Lung
Multiple Organ Failure
Lung Transplantation
Adiposity
Pandemics
Critical Care
Septic Shock
Alcoholism
Intensive Care Units
Swine
Hemorrhage
Infection

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Pabst, Dirk ; Kuehn, Joachim ; Schuler-Luettmann, Susanne ; Wiebe, Karsten ; Lebiedz, Pia. / Acute Respiratory Distress Syndrome as a presenting manifestation in young patients infected with H1N1 influenza virus. In: European Journal of Internal Medicine. 2011 ; Vol. 22, No. 6.
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Acute Respiratory Distress Syndrome as a presenting manifestation in young patients infected with H1N1 influenza virus. / Pabst, Dirk; Kuehn, Joachim; Schuler-Luettmann, Susanne; Wiebe, Karsten; Lebiedz, Pia.

In: European Journal of Internal Medicine, Vol. 22, No. 6, 01.12.2011.

Research output: Contribution to journalArticle

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AU - Kuehn, Joachim

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AU - Wiebe, Karsten

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N2 - Introduction: The new strain of influenza A (H1N1) 2009, often referred to colloquially as "swine flu", which was first detected in April 2009, raised to a pandemic of which the impact was not completely predictable. As reported, numerous cases with severe respiratory failure were also seen among young previously healthy people. Patients: In the present study, we report eight cases of influenza A (H1N1) 2009 admitted to our medical intensive care with severe respiratory failure between November and December 2009 and in January 2011. All patients were older than 30 but younger than 50 years, had clinical and radiological evidence of an Acute Respiratory Distress Syndrome (ARDS) and needed invasive ventilatory support. Results: Six of the eight patients had no relevant underlying disease; one had a pre-existing idiopathic lung fibrosis and another had a chronic obstructive pulmonary disease (COPD), an abuse of alcohol and an adiposities grade 3. Four patients needed an extracorporeal membrane oxygenation (ECMO) due to severe respiratory failure with global respiratory insufficiency that could not be treated by conservative ventilatory support. The one patient with a pre-existing lung fibrosis died shortly after lung transplantation despite use of an extracorporeal membrane oxygenation. One other patient died due to a subarachnoidal bleeding under the anticoagulatory regime during ECMO therapy. The adipose COPD-patient died due to septic shock with multiple organ failure without possibility for ECMO support. Conclusions: The clinical course of severe cases of influenza A (H1N1) 2009-infection is markedly different from the disease pattern seen during epidemics of seasonal influenza. Most of the patients admitted to our intensive care unit due to influenza A (H1N1) 2009 associated ARDS were previously healthy young people.

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