RISK STRATIFICATION FOR THE DEVELOPMENT OF RESPIRATORY FAILURE IN H1N1 VIRAL INFECTION AND THE ROLE OF EARLY NONINVASIVE VENTILATION IN PREVENTING INVASIVE MECHANICAL VENTILATION

Abstract

SESSION TITLE: Outcomes and Management of Viral Infections in the ICU SESSION TYPE: Original Investigations PRESENTED ON: 10/08/2018 04:30 PM - 05:30 PM PURPOSE: The 21st century Influenza A (H1N1) pandemic has posed serious public health challenge world-wide, infecting about 200 million people during 2009-10. There has been an extensive workup regarding the clinico-radiological profile and the outcomes of H1N1 cases in various geographic regions of the World. However, there is a deficit in the knowledge regarding the risk stratification for the development of respiratory failure in them. Risk stratification can assist in prioritizing clinical workflow, reducing system waste, and creating financially efficient population management. METHODS: In the retrospective analysis of 203 laboratory confirmed adult inpatients of H1N1 viral infection from Jan 2015 to Oct 2017, we studied the association between various co-morbid conditions with the development of respiratory failure in them. We studied the role of Non-invasive ventilation in preventing invasive mechanical ventilation in cases with respiratory failure. RESULTS: Of 203 patients, 19/22 (86.3%) patients with Obesity (p value=0.0011), and 29/42 (69%) patients with Diabetes mellitus developed respiratory failure (p=0.0235) which were found statistically significant.9/11 (81.8%) patients with Chronic Kidney Disease (p=0.0625) and 15/22 (68.1%) patients with Pregnancy or immediate postpartum period developed respiratory failure (p=0.0693), which were close to statistical significance.8/10 (80%) with Pulmonary tuberculosis (p=0.1059),9/15 (60%) with Hypothyroidism (p=0.6018),13/22 (59%) with Cardiac diseases (p=0.6524),30/55 (54.5%) with Hypertension (p=0.8744),6/11 (54.5%) with COAD (p=1.00),4/8 (50%) with Bronchial asthma (p=1.00),1/2(50%) with Chronic liver disease (p=1.00) developed respiratory failure which were statistically insignificant.107/203 (52.7%) developed respiratory failure, of which 33 patients (30.8%) recovered with oxygen supplementation alone, while 23 patients were directly intubated. 51 patients required NIV, of which 26 (50.9%) improved and 23 patients further required invasive mechanical ventilation.Statistically significant improvement with NIV was noted in H1N1 infected patients with Obesity or Diabetes (p =0.0201, 0.0483 resp.) CONCLUSIONS: There is a statistically significant higher risk of development of respiratory failure in patients with Obesity or Diabetes mellitus with H1N1 viral infection. There is an increased risk in patients with acute renal dysfunction or pregnancy/immediate post-partum period with H1N1 infection.Early NIV has resulted in recovery of 26/51 (50.9%) patients with respiratory failure, who would otherwise have had gone for invasive mechanical ventilation directly. CLINICAL IMPLICATIONS: Our study showed that obese or diabetic patients with H1N1 viral infection are at a higher risk of development of respiratory failure, and NIV maybe attempted as a first line ventilatory strategy in them, carefully guided by an improvement in oxygenation parameters. DISCLOSURES: No relevant relationships by Vedaranya Garikapati, source=Web Response No relevant relationships by Raja Rao M, source=Web Response No relevant relationships by Krishna murthy M. G., source=Web Response No relevant relationships by Pramod Kumar Tarigopula, source=Web Response