Clinical Findings in Albanian Patients with 2009 Influenza AH1N1 Admitted at the Intensive Care Unit

Arben Ndreu,Ervin Çerçiz Mingomataj,Artan Simaku,Shane Morrison,Dhimitër Kraja,Iris Hatibi,Arjan Harxhi,Silva Bino,Ilir Ohri,Hektor Sula,Entela Kolovani,Vania Rashidi,Arben Pilaca,Najada Çomo,Kastriot Shytaj

doi:10.1155/2013/914840

Abstract

Due to the ease of cross-continent spread of infectious diseases, the 2009 influenza AH1N1 (H1N1) affected many countries. This observational prospective study looked at Albanian patients admitted with 2009 H1N1 at the ICU of the Department of Infectious Diseases at the University Hospital Center of Tirana, from November 2009 to March 2010. Demographic data, symptoms, comorbidities, and clinical outcomes were collected from each patient. The number of days spent in the ICU was recorded for each patient along with their radiological and laboratory findings, and outcome at discharge. Critical illness occurred in 31 patients admitted with confirmed 2009 H1N1. The median age of patients was 35 years. Five (16.1%) patients required endotracheal intubation; noninvasive oxygen therapy (NIV) was used in 15 (48.4%) patients via nasal tube; and continuous positive airway pressure (CPAP) and pressure support ventilation (PSV) oxygen masks were used in 11 (35.5%) patients. All patients were treated with oseltamivir. Four patients admitted and treated did not survive. Critical illness in the setting of 2009 H1N1 admitted in the ICU predominantly affected young adults. NIV could play a role in treating 2009 influenza H1N1 infection-related hypoxemic respiratory failure that was associated with severe hypoxemia, pneumonia, requirement for prolonged mechanical ventilation, and the frequent use of antiviral therapy.

Highlights

In April 2009, a new strain of human H1N1 influenza A virus (H1N1) was identified in the US [1, 2]
Along with the aforementioned symptoms, the influenza H1N1 virus has been associated with acute respiratory distress syndrome and pneumonia [5, 6]
From July to October 2009, Albania experienced a moderate wave of viral transmission; a stronger wave began in November, and a peak in H1N1 incidence occurred during the first week of December 2009

Summary

Introduction

In April 2009, a new strain of human H1N1 influenza A virus (H1N1) was identified in the US [1, 2]. The number of H1N1-related cases worldwide showing symptoms ranging from fever and cough to diarrhea and vomiting was in the thousands [3, 4]. Along with the aforementioned symptoms, the influenza H1N1 virus has been associated with acute respiratory distress syndrome and pneumonia [5, 6]. The first laboratory-confirmed case of novel pandemic influenza H1N1 2009 in Albania was reported on May 2009. The hospitalization rates were reported every week during the influenza season, which allowed for the collection of information on the number of people with influenza-related complications and total number of such patients admitted into the ICU (Figure 1). The aim of this study was to describe clinical characteristics of ICU admissions, demographic characteristics, and compare treatments to their respective outcomes among critically ill patients with laboratory-confirmed H1N1 virus. Treatment methods include the use of antiviral, and if ISRN Emergency Medicine

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