H1N1-infected Patients in ICU and Their Clinical Outcome

The swine flu (H1N1) with rapid spread and panic in population is truly global pandemic, affected mainly younger population. There is need to accumulate evidence regarding patient's intensive care parameters for effective management of newer strains of influenza viral infections. Hence an observed retrospective record analysis of confirmed H1N1 patients admitted to intensive care unit (ICU) of a tertiary care centre is done.

The study was designed to study the profile and pattern of H1N1 patients admitted to ICU and to study the distribution and associated factors with treatment outcomes.

The demographic, clinical, and laboratory data of 32 (RT-PCR confirmed) H1N1cases were collected and analyzed using Fischer's exact test/paired t test between survivors and nonsurvivors to know their significance. This data included criteria for admission to ICU, type of lung injury, mode of oxygenation, antiviral, and other drugs used.

There were 11 males and 21 female. Age ranged from 19 to 72 years. Age group of 15-45 years had most cases (78%) and mortality (60%). Most common symptoms were fever and breathlessness (100%). The mean duration of breathlessness was statistically significant (P = 0.037) between two groups. Most common signs were tachycardia and tachypnea. The 75% cases developed acute respiratory distress syndrome (ARDS), of this 16% survived. Among these fatal cases nine were positive for procalcitonin (PCT) (P = 0.006). The rest of 25% developed acute lung injury (ALI) and recovered completely (P = 0.0001).

Fever and breathlessness were the main presenting complaints. Tachypnea and tachycardia as clinical signs predict development of respiratory complications. Arterial blood gas analysis (ABG) and PaO(2)/FiO(2) were important in deciding severity of lung injury and mode of ventilation. ARDS was observed to be the main cause of mortality in this study. Serum PCT level estimation is useful in determining outcome.