Acute respiratory distress syndrome during the 2009 H1N1 influenza A pandemic in Ecuador

Objective: Among the most severe complications caused by the influenza A virus H1N1 pandemic is the Acute Respiratory Distress Syndrome (ARDS). The main objective of this study was to assess mortality after applying a strict protocol of ventilatory management and to describe the clinical characteristics of the patients. Design: A prospective cohort study. Setting: Intensive care unit (ICU) of the Hospital Enrique Garces of the City of Quito. Patients: Patients admitted to the ICU with a diagnosis of severe pneumonia, ARDS, and high suspicion of influenza A H1N1. Primary variables of interest: Demographic variables, severity, diagnostic scores of community-acquired pneumonia, ventilator management protocol and mortality at 28 days, as principal effect of the study, were collected. Results: 24 patients were studied, 100% with a diagnosis of ARDS, mean age 41.1 (+/- 14.8). Severe viral pneumonia predominated in these patients, mean APACHE was 18, average PaO2/FiO(2) on admission was 74.9, 100% had multisystemic involvement. A total of 91.3% received oseltamivir 150 mg w/12 h for 14 days, the mean time between onset of symptoms and antiviral administration was 6.74 days. Intra-ICU mortality was 16.6%, and 28 days was 16.6%. Conclusions: After applying a strict management protocol for ventilatory management, mortality in this patient group was 16.6. We also stress that obesity and early renal failure were independent risk factors for mortality. (C) 2009 Elsevier Espana, S.L. and SEMICYUC. All rights reserved.