Chest
Volume 142, Issue 3, September 2012, Pages 583-592
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Original Research
Critical Care
Long-term Outcomes of Pandemic 2009 Influenza A(H1N1)-Associated Severe ARDS

https://doi.org/10.1378/chest.11-2196Get rights and content

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.

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.

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

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