An assessment of H1N1 influenza-associated acute respiratory distress syndrome severity after adjustment for treatment characteristics

Brent P. Riscili, Tyler B. Anderson, Hallie C. Prescott, Matthew C. Exline, Madhuri M. Sopirala, Gary S. Phillips, Naeem A. Ali

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Pandemic influenza caused significant increases in healthcare utilization across several continents including the use of high-intensity rescue therapies like extracorporeal membrane oxygenation (ECMO) or high-frequency oscillatory ventilation (HFOV). The severity of illness observed with pandemic influenza in 2009 strained healthcare resources. Because lung injury in ARDS can be influenced by daily management and multiple organ failure, we performed a retrospective cohort study to understand the severity of H1N1 associated ARDS after adjustment for treatment. Sixty subjects were identified in our hospital with ARDS from "direct injury" within 24 hours of ICU admission over a three month period. Twenty-three subjects (38.3%) were positive for H1N1 within 72 hours of hospitalization. These cases of H1N1-associated ARDS were compared to non-H1N1 associated ARDS patients. Subjects with H1N1-associated ARDS were younger and more likely to have a higher body mass index (BMI), present more rapidly and have worse oxygenation. Severity of illness (SOFA score) was directly related to worse oxygenation. Management was similar between the two groups on the day of admission and subsequent five days with respect to tidal volumes used, fluid balance and transfusion practices. There was, however, more frequent use of "rescue" therapy like prone ventilation, HFOV or ECMO in H1N1 patients. First morning set tidal volumes and BMI were significantly associated with increased severity of lung injury (Lung injury score, LIS) at presentation and over time while prior prescription of statins was protective. After assessment of the effect of these co-interventions LIS was significantly higher in H1N1 patients. Patients with pandemic influenza-associated ARDS had higher LIS both at presentation and over the course of the first six days of treatment when compared to non-H1N1 associated ARDS controls. The difference in LIS persisted over the duration of observation in patients with H1N1 possibly explaining the increased duration of mechanical ventilation.

Original languageEnglish (US)
Article numbere18166
JournalPloS one
Volume6
Issue number3
DOIs
StatePublished - Mar 30 2011
Externally publishedYes

Fingerprint

Oxygenation
Adult Respiratory Distress Syndrome
Lung Injury
influenza
Human Influenza
lungs
Ventilation
Pandemics
pandemic
High-Frequency Ventilation
tidal volume
Extracorporeal Membrane Oxygenation
Tidal Volume
Membranes
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Intensive care units
health services
body mass index
Body Mass Index
Therapeutics

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

An assessment of H1N1 influenza-associated acute respiratory distress syndrome severity after adjustment for treatment characteristics. / Riscili, Brent P.; Anderson, Tyler B.; Prescott, Hallie C.; Exline, Matthew C.; Sopirala, Madhuri M.; Phillips, Gary S.; Ali, Naeem A.

In: PloS one, Vol. 6, No. 3, e18166, 30.03.2011.

Research output: Contribution to journalArticle

Riscili, Brent P. ; Anderson, Tyler B. ; Prescott, Hallie C. ; Exline, Matthew C. ; Sopirala, Madhuri M. ; Phillips, Gary S. ; Ali, Naeem A. / An assessment of H1N1 influenza-associated acute respiratory distress syndrome severity after adjustment for treatment characteristics. In: PloS one. 2011 ; Vol. 6, No. 3.
@article{a281900a882a4c82bd66a45727e9583b,
title = "An assessment of H1N1 influenza-associated acute respiratory distress syndrome severity after adjustment for treatment characteristics",
abstract = "Pandemic influenza caused significant increases in healthcare utilization across several continents including the use of high-intensity rescue therapies like extracorporeal membrane oxygenation (ECMO) or high-frequency oscillatory ventilation (HFOV). The severity of illness observed with pandemic influenza in 2009 strained healthcare resources. Because lung injury in ARDS can be influenced by daily management and multiple organ failure, we performed a retrospective cohort study to understand the severity of H1N1 associated ARDS after adjustment for treatment. Sixty subjects were identified in our hospital with ARDS from {"}direct injury{"} within 24 hours of ICU admission over a three month period. Twenty-three subjects (38.3{\%}) were positive for H1N1 within 72 hours of hospitalization. These cases of H1N1-associated ARDS were compared to non-H1N1 associated ARDS patients. Subjects with H1N1-associated ARDS were younger and more likely to have a higher body mass index (BMI), present more rapidly and have worse oxygenation. Severity of illness (SOFA score) was directly related to worse oxygenation. Management was similar between the two groups on the day of admission and subsequent five days with respect to tidal volumes used, fluid balance and transfusion practices. There was, however, more frequent use of {"}rescue{"} therapy like prone ventilation, HFOV or ECMO in H1N1 patients. First morning set tidal volumes and BMI were significantly associated with increased severity of lung injury (Lung injury score, LIS) at presentation and over time while prior prescription of statins was protective. After assessment of the effect of these co-interventions LIS was significantly higher in H1N1 patients. Patients with pandemic influenza-associated ARDS had higher LIS both at presentation and over the course of the first six days of treatment when compared to non-H1N1 associated ARDS controls. The difference in LIS persisted over the duration of observation in patients with H1N1 possibly explaining the increased duration of mechanical ventilation.",
author = "Riscili, {Brent P.} and Anderson, {Tyler B.} and Prescott, {Hallie C.} and Exline, {Matthew C.} and Sopirala, {Madhuri M.} and Phillips, {Gary S.} and Ali, {Naeem A.}",
year = "2011",
month = "3",
day = "30",
doi = "10.1371/journal.pone.0018166",
language = "English (US)",
volume = "6",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "3",

}

TY - JOUR

T1 - An assessment of H1N1 influenza-associated acute respiratory distress syndrome severity after adjustment for treatment characteristics

AU - Riscili, Brent P.

AU - Anderson, Tyler B.

AU - Prescott, Hallie C.

AU - Exline, Matthew C.

AU - Sopirala, Madhuri M.

AU - Phillips, Gary S.

AU - Ali, Naeem A.

PY - 2011/3/30

Y1 - 2011/3/30

N2 - Pandemic influenza caused significant increases in healthcare utilization across several continents including the use of high-intensity rescue therapies like extracorporeal membrane oxygenation (ECMO) or high-frequency oscillatory ventilation (HFOV). The severity of illness observed with pandemic influenza in 2009 strained healthcare resources. Because lung injury in ARDS can be influenced by daily management and multiple organ failure, we performed a retrospective cohort study to understand the severity of H1N1 associated ARDS after adjustment for treatment. Sixty subjects were identified in our hospital with ARDS from "direct injury" within 24 hours of ICU admission over a three month period. Twenty-three subjects (38.3%) were positive for H1N1 within 72 hours of hospitalization. These cases of H1N1-associated ARDS were compared to non-H1N1 associated ARDS patients. Subjects with H1N1-associated ARDS were younger and more likely to have a higher body mass index (BMI), present more rapidly and have worse oxygenation. Severity of illness (SOFA score) was directly related to worse oxygenation. Management was similar between the two groups on the day of admission and subsequent five days with respect to tidal volumes used, fluid balance and transfusion practices. There was, however, more frequent use of "rescue" therapy like prone ventilation, HFOV or ECMO in H1N1 patients. First morning set tidal volumes and BMI were significantly associated with increased severity of lung injury (Lung injury score, LIS) at presentation and over time while prior prescription of statins was protective. After assessment of the effect of these co-interventions LIS was significantly higher in H1N1 patients. Patients with pandemic influenza-associated ARDS had higher LIS both at presentation and over the course of the first six days of treatment when compared to non-H1N1 associated ARDS controls. The difference in LIS persisted over the duration of observation in patients with H1N1 possibly explaining the increased duration of mechanical ventilation.

AB - Pandemic influenza caused significant increases in healthcare utilization across several continents including the use of high-intensity rescue therapies like extracorporeal membrane oxygenation (ECMO) or high-frequency oscillatory ventilation (HFOV). The severity of illness observed with pandemic influenza in 2009 strained healthcare resources. Because lung injury in ARDS can be influenced by daily management and multiple organ failure, we performed a retrospective cohort study to understand the severity of H1N1 associated ARDS after adjustment for treatment. Sixty subjects were identified in our hospital with ARDS from "direct injury" within 24 hours of ICU admission over a three month period. Twenty-three subjects (38.3%) were positive for H1N1 within 72 hours of hospitalization. These cases of H1N1-associated ARDS were compared to non-H1N1 associated ARDS patients. Subjects with H1N1-associated ARDS were younger and more likely to have a higher body mass index (BMI), present more rapidly and have worse oxygenation. Severity of illness (SOFA score) was directly related to worse oxygenation. Management was similar between the two groups on the day of admission and subsequent five days with respect to tidal volumes used, fluid balance and transfusion practices. There was, however, more frequent use of "rescue" therapy like prone ventilation, HFOV or ECMO in H1N1 patients. First morning set tidal volumes and BMI were significantly associated with increased severity of lung injury (Lung injury score, LIS) at presentation and over time while prior prescription of statins was protective. After assessment of the effect of these co-interventions LIS was significantly higher in H1N1 patients. Patients with pandemic influenza-associated ARDS had higher LIS both at presentation and over the course of the first six days of treatment when compared to non-H1N1 associated ARDS controls. The difference in LIS persisted over the duration of observation in patients with H1N1 possibly explaining the increased duration of mechanical ventilation.

UR - http://www.scopus.com/inward/record.url?scp=79953057698&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79953057698&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0018166

DO - 10.1371/journal.pone.0018166

M3 - Article

C2 - 21464952

AN - SCOPUS:79953057698

VL - 6

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 3

M1 - e18166

ER -