Chest
Original ResearchCritical CareLong-term Outcomes of Pandemic 2009 Influenza A(H1N1)-Associated Severe ARDS
Section snippets
Patients
The Réseau Européen de Ventilation Artificielle (REVA) registry, established just after the second pandemic wave reached France in autumn 2009 and supported by the Société de Réanimation de Langue Française, was the source of the selected patients in the ICU, hospitalized for severe A(H1N1) infection and included over a 4-month period (November 2009 through March 2010). Via a Web-based registry, patients were simultaneously entered and mandatorily reported to the National Institute for Public
Results
Among the 566 patients with confirmed or strongly suspected A(H1N1) infection admitted to the 121 ICUs participating in the REVA registry, 342 (60.4%) had a final diagnosis of ARDS, and, among the 67 requiring ECLA, 43 survived. Sixteen of the survivors met the inclusion criteria and were eligible for this study. Among the 275 patients with ARDS not requiring ECLA, 199 survived and 56 met the inclusion criteria. Twelve of the 16 ECLA and 25 of the 56 no-ECLA group patients agreed to participate
Discussion
The results of this prospective observational study showed that survivors of ARDS due to A(H1N1)-associated pneumonia had mild disabilities 1 year post-ICU discharge; most of them had no demonstrable weakness by MRC testing and had returned to work, and some practiced sports regularly. Pulmonary function was near normal, but most patients had decreased diffusion capacity across the blood-gas barrier and exercise limitations. A chest CT scan was abnormal in most patients, but there were minor
Conclusion
One year post-ICU discharge, survivors of A(H1N1)-associated ARDS had minor lung disabilities, with diminished blood-gas diffusion capacities for a majority. Most had lower HRQoL scores than a sex- and age-matched French general population, reported anxiety and/or depression, and were at risk for PTSD. ECLA use for the most severely ill patients was not associated with worse long-term lung disabilities, HRQoL, or psychologic impairment.
Acknowledgments
Author contributions: Dr Luyt is the guarantor of the manuscript.
Dr Luyt: contributed to study conception and design; acquisition, analysis, and interpretation of data; drafting of the article; and revising, reading, and approving the final version of the article.
Dr Combes: contributed to study conception and design; acquisition, analysis, and interpretation of data; drafting of the article; and revising, reading, and approving the final version of the article.
Dr Becquemin: contributed to
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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.
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