Intensive Care Med (2014) 40:131–132 DOI 10.1007/s00134-013-3143-1
LETTER
All patients except one had been vaccinated against influenza. abnormal findings on chest radiogOnly two patients received steroids raphy. Table 1 shows the laboratory (renal transplantation and pulmonary findings. Eleven patients were fibrosis) since steroids are associated admitted for respiratory failure rela- with increased risk of superinfections ted to viral pneumonitis, one for [4]. The hospital fatality rate was as myocarditis, one for ketoacidosis, high as 46.0 %. In such a small one for renal failure, and one for population, correlation between the cardiac arrest. As mean time severity and type of influenza and New patterns of A(H1N1)pdm09 between onset of clinical signs and mortality predictions for the coming ICU admission was 7.7 ± 7.4 days, winter epidemic in mainland France influenza in the Southern only seven patients had received oral cannot be ascertained. Hemisphere oseltamivir. Thirteen patients In 2009 and 2010, our severe cases required mechanical ventilation dur- of influenza A(H1N1)pdm09 affected Received: 19 October 2013 ing 12.5 ± 10.1 days. As rescue mainly healthy young persons, pregAccepted: 21 October 2013 therapy, one patient required highnant women, or obese subjects with a Published online: 5 November 2013 frequency ventilation, four nitrogen median age of 32 [24; 54] years [5]. Ó Springer-Verlag Berlin Heidelberg and monoxide, and four ECMO (ECMO Four years later, A(H1N1)pdm09 ESICM 2013 net score [2]: 3.5, 3.5, 4, and 6). persists with different epidemiologiAmong them, a woman who subse- cal patterns. A(H1N1)pdm09 has quently died had a BMI of 66 kg/m2; been integrated in the seasonal flu. high body weight is not a contrain- Severe cases occurred in older Dear Editor, patients having more co-morbidities, dication to initiation of ECMO in Influenza surveillance in Reunion admitted with more serious condiadult patients [3]. All patients but Island (Indian Ocean) provides reli- one were given probabilistic antitions as evidenced by a higher SOFA able and timely information that can bacterial drugs. Six patients had co- score: 9.8 ± 4.8. It would be notehelp predict the epidemiologic distri- infections: three by Streptococcus worthy to confirm these observations bution and patterns in mainland pneumoniae and three by methicillin- with that of the coming winter season France [1], since the outbreaks of in Europe. susceptible Staphylococcus aureus. influenza are observed several months None of the 12 patients targeted by earlier than in Europe. During the Conflicts of interest None. vaccination recommendations had 2013 influenza season, the surveillance system showed a moderate epidemic in the general population Table 1 Demographic data, prognostic factors, and main laboratory results in 15 cases of that lasted 8 weeks and peaked in severe ICU cases in Re´union week 26. We report more severe Patients (N = 15) A(H1N1)pdm09 (N = 8) influenza cases than during the previous 2 years. Median age 59 [49; 67] 55.5 [49.5; 59.75] We report 15 patients with severe Sex ratio (M/F) 8/7 6/2 influenza hospitalized in the largest BMI 25 [21.8; 26.8] 25.2 [23.7; 27] 12 6 ICU of Reunion Island from 1 June to Comorbidity Coinfection (%) 40 37.5 30 September 2013. Diagnosis was Hospital mortality (%) 46 50 confirmed by RT-PCR. Eight cases ECLS/ECMO 4 2 were identified as A(H1N1)pdm09 ECMO net score [2] 3.75 [3.5; 4] 3.5 SOFA score 9 [6; 13.5] 7 [5.5; 9.25] and six as influenza A, including 11.5 [9.25; 20.75] 12.5 [10.75; 22.5] three A(H3N2) and one influenza B. Duration of stay in ICU Duration of mechanical ventilation 9 [5; 17.25] 11.5 [7.5; 20] Thirteen patients had underlying Thrombocytopenia \150 9 109/L (%) 60 50 concurrent medical conditions: Lymphopenia \1.5 9 109/l (%) 93 100 hypertension (8/15), chronic respira- ALAT 43 [23.5; 55.5] 44 [35.5; 80] 63 [46; 132.5] 97 [56.75; 164] tory diseases (6/15), diabetes (5/15), ASAT Creatinine 116 [70; 180] 82.5 [66; 132] chronic cardiac diseases (2/15), Lactate 2.6 [1.85; 3.85] 2.15 [1.55; 3.05] immunosuppression (2/15), and Results are given in median [quartile 1; quartile 3] overweight (3/15). David Vandroux Elise Brottet Lionel Ursulet Marion Angue Julien Jabot Laurent Filleuil Bernard-Alex Gauzere
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References 1. Filleul L, Brottet E, Gau¨zere BA, Winer A, Vandroux D, Michault A et al (2012) Reunion, a sentinel territory for influenza surveillance in Europe. Euro Surveill 17(27) (pii:20212) 2. Pappalardo F, Pieri M, Greco T, Patroniti N, Pesenti A, Arcadipane A et al (2013) Predicting mortality risk in patients undergoing venovenous ECMO for ARDS due to influenza A(H1N1) pneumonia: the ECMOnet score. Intensive Care Med 39(2):275–281
3. Al-Soufi S, Busher H, Nguyen ND, Rycus P, Nair P (2013) Lack of association between body weight and mortality in patients on veno-venous extracorporeal membrane oxygenation. Intensive Care Med 39(11):1995–2002 4. Martin-Loeches I, Lisboa T, Rhodes A, Moreno RP, Silva E, Sprung C et al (2011) Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection. Intensive Care Med 37(2):272–283
5. Gau¨ze`re BA, Malvy D, Filleul L, Ramful D et al (2011) Intensive Care Unit Admission for pandemic (H1N1)2009, Reunion Island 2009. Emerg Infect Dis 17(1):140–141 D. Vandroux ()) L. Ursulet M. Angue J. Jabot B.-A. Gauzere CHU La Re´union, Saint Denis de La Re´union, France e-mail: [email protected] E. Brottet L. Filleuil CIRE Oce´an Indien, Saint Denis de La Re´union, France
LETTER
All patients except one had been vaccinated against influenza. abnormal findings on chest radiogOnly two patients received steroids raphy. Table 1 shows the laboratory (renal transplantation and pulmonary findings. Eleven patients were fibrosis) since steroids are associated admitted for respiratory failure rela- with increased risk of superinfections ted to viral pneumonitis, one for [4]. The hospital fatality rate was as myocarditis, one for ketoacidosis, high as 46.0 %. In such a small one for renal failure, and one for population, correlation between the cardiac arrest. As mean time severity and type of influenza and New patterns of A(H1N1)pdm09 between onset of clinical signs and mortality predictions for the coming ICU admission was 7.7 ± 7.4 days, winter epidemic in mainland France influenza in the Southern only seven patients had received oral cannot be ascertained. Hemisphere oseltamivir. Thirteen patients In 2009 and 2010, our severe cases required mechanical ventilation dur- of influenza A(H1N1)pdm09 affected Received: 19 October 2013 ing 12.5 ± 10.1 days. As rescue mainly healthy young persons, pregAccepted: 21 October 2013 therapy, one patient required highnant women, or obese subjects with a Published online: 5 November 2013 frequency ventilation, four nitrogen median age of 32 [24; 54] years [5]. Ó Springer-Verlag Berlin Heidelberg and monoxide, and four ECMO (ECMO Four years later, A(H1N1)pdm09 ESICM 2013 net score [2]: 3.5, 3.5, 4, and 6). persists with different epidemiologiAmong them, a woman who subse- cal patterns. A(H1N1)pdm09 has quently died had a BMI of 66 kg/m2; been integrated in the seasonal flu. high body weight is not a contrain- Severe cases occurred in older Dear Editor, patients having more co-morbidities, dication to initiation of ECMO in Influenza surveillance in Reunion admitted with more serious condiadult patients [3]. All patients but Island (Indian Ocean) provides reli- one were given probabilistic antitions as evidenced by a higher SOFA able and timely information that can bacterial drugs. Six patients had co- score: 9.8 ± 4.8. It would be notehelp predict the epidemiologic distri- infections: three by Streptococcus worthy to confirm these observations bution and patterns in mainland pneumoniae and three by methicillin- with that of the coming winter season France [1], since the outbreaks of in Europe. susceptible Staphylococcus aureus. influenza are observed several months None of the 12 patients targeted by earlier than in Europe. During the Conflicts of interest None. vaccination recommendations had 2013 influenza season, the surveillance system showed a moderate epidemic in the general population Table 1 Demographic data, prognostic factors, and main laboratory results in 15 cases of that lasted 8 weeks and peaked in severe ICU cases in Re´union week 26. We report more severe Patients (N = 15) A(H1N1)pdm09 (N = 8) influenza cases than during the previous 2 years. Median age 59 [49; 67] 55.5 [49.5; 59.75] We report 15 patients with severe Sex ratio (M/F) 8/7 6/2 influenza hospitalized in the largest BMI 25 [21.8; 26.8] 25.2 [23.7; 27] 12 6 ICU of Reunion Island from 1 June to Comorbidity Coinfection (%) 40 37.5 30 September 2013. Diagnosis was Hospital mortality (%) 46 50 confirmed by RT-PCR. Eight cases ECLS/ECMO 4 2 were identified as A(H1N1)pdm09 ECMO net score [2] 3.75 [3.5; 4] 3.5 SOFA score 9 [6; 13.5] 7 [5.5; 9.25] and six as influenza A, including 11.5 [9.25; 20.75] 12.5 [10.75; 22.5] three A(H3N2) and one influenza B. Duration of stay in ICU Duration of mechanical ventilation 9 [5; 17.25] 11.5 [7.5; 20] Thirteen patients had underlying Thrombocytopenia \150 9 109/L (%) 60 50 concurrent medical conditions: Lymphopenia \1.5 9 109/l (%) 93 100 hypertension (8/15), chronic respira- ALAT 43 [23.5; 55.5] 44 [35.5; 80] 63 [46; 132.5] 97 [56.75; 164] tory diseases (6/15), diabetes (5/15), ASAT Creatinine 116 [70; 180] 82.5 [66; 132] chronic cardiac diseases (2/15), Lactate 2.6 [1.85; 3.85] 2.15 [1.55; 3.05] immunosuppression (2/15), and Results are given in median [quartile 1; quartile 3] overweight (3/15). David Vandroux Elise Brottet Lionel Ursulet Marion Angue Julien Jabot Laurent Filleuil Bernard-Alex Gauzere
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References 1. Filleul L, Brottet E, Gau¨zere BA, Winer A, Vandroux D, Michault A et al (2012) Reunion, a sentinel territory for influenza surveillance in Europe. Euro Surveill 17(27) (pii:20212) 2. Pappalardo F, Pieri M, Greco T, Patroniti N, Pesenti A, Arcadipane A et al (2013) Predicting mortality risk in patients undergoing venovenous ECMO for ARDS due to influenza A(H1N1) pneumonia: the ECMOnet score. Intensive Care Med 39(2):275–281
3. Al-Soufi S, Busher H, Nguyen ND, Rycus P, Nair P (2013) Lack of association between body weight and mortality in patients on veno-venous extracorporeal membrane oxygenation. Intensive Care Med 39(11):1995–2002 4. Martin-Loeches I, Lisboa T, Rhodes A, Moreno RP, Silva E, Sprung C et al (2011) Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection. Intensive Care Med 37(2):272–283
5. Gau¨ze`re BA, Malvy D, Filleul L, Ramful D et al (2011) Intensive Care Unit Admission for pandemic (H1N1)2009, Reunion Island 2009. Emerg Infect Dis 17(1):140–141 D. Vandroux ()) L. Ursulet M. Angue J. Jabot B.-A. Gauzere CHU La Re´union, Saint Denis de La Re´union, France e-mail: [email protected] E. Brottet L. Filleuil CIRE Oce´an Indien, Saint Denis de La Re´union, France
