Epidemiology and Outcomes of HIN1 Pneumonia in ICU

Abstract

Introduction: Pandemic influenza H1N1/09 emerged for the first time in April 2009 and has spread widely across India since then. The number of cases have increased over time with the increasing need for respiratory support, causing significant morbidity and mortality. We evaluated the clinical course and outcomes of patients infected with Influenza A (H1N1) admitted to three multidisciplinary intensive care units (ICU) in Chennai. Materials and methods: We performed a combined retrospective and prospective observational study of all patients admitted with H1N1 pneumonia at three multidisciplinary ICUs in Chennai from October 1, 2018, to January 31, 2019. Data including demographics, risk factors, and clinical courses were recorded. Outcome data including mortality was tracked up to 28 days. Results: A total of 167 patients were admitted during the study period of which 154 were included in this analysis. The mean age of presentation was 58.2 + 15.6 years and 59.1% of them were males. The mean acute physiology and chronic health evaluation (APACHE) IV and sequential organ failure assessment (SOFA) scores were 62.8 + 23.2 and 5.8 + 3.9 respectively. Oxygen delivery devices were required in 25.3% for a mean duration of 26.5 + 5.7 hours. Non-invasive ventilation or high flow nasal cannula (HFNC) was needed in 33.1% of patients for 59.9 + 64.5 hours. The proportion of patients requiring mechanical ventilation was 41.6%. Rescue measures in the form of proning, use of inhaled nitric oxide (iNO), and extracorporeal membrane oxygenation (ECMO) were initiated for refractory hypoxemia in 26.6%, 14.1%, and 6.3% respectively. The mean duration of ventilator support was 8.5 + 8 days. Tracheostomy was required in 20.3% of patients and 7.8% were ventilator dependent at 28 days. The mean ICU and Hospital length of stay were 8.3 + 10.3 and 12.2 + 14.1 days respectively and overall 28-day mortality was 20.1%. Conclusion: A significant proportion of H1N1 patients admitted to the ICU required high-level respiratory support including non-invasive ventilation (NIV), HFNC, or invasive ventilation. Deployment of rescue therapies was common and the overall mortality rate was similar to those reported from Western countries.