30). A média do escore Acute Physiologic Chronic Heatlh Evaluation II (APACHE II) foi de 15,0 ± 8,1. A mortalidade na unidade de terapia intensiva foi de 39,7%. Os principais fatores associados a essa mortalidade foram exame positivo no teste RT-PCR, níveis baixos de relação PaO2/FiO2 inicial, níveis elevados de uréia e desidrogenase lática iniciais, nível de pressão expiratória final positiva necessária, necessidade de posição prona e de drogas vasopressoras. CONCLUSÕES: Pacientes admitidos em unidades de terapia intensiva com infecção por vírus A(H1N1) apresentaram alto risco de óbito, particularmente devidos ao comprometimento respiratório. O exame RT-PCR positivo, níveis de uréia e de desidrogenase láctica, além baixa PaO2/FiO2 e necessidades de PEEP alta, foram relacionados com uma maior mortalidade.]]>

Objective: To analyze the histopathological lung findings of four fatal cases of the 2009 H1N1 influenza pandemic and their correlation with clinical and epidemiological characteristics. Methods: Descriptive data from medical records of four patients who died in the Intensive Care Unit of a university hospital in 2009. Nasopharyngeal aspirate specimens were collected from the patients and were analyzed by real-time polymerase chain reaction. Lung biopsy was performed post mortem; a score of intensity for pathological changes was applied. Results: Three patients had positive real-time polymerase chain reaction (although all of them had a clinical diagnose of influenza H1N1). The main histopathological changes were: exudative diffuse alveolar damage with atelectasis; varying degrees of alveolar hemorrhage and edema, necrosis and sloughing of the respiratory epithelium in several bronchioli; and thrombus formation. One of the patients (the pregnant one) presented histopathological findings of cytomegalic inclusion. Conclusion: The pulmonary histopathological findings in patients with fatal 2009 H1N1 influenza pandemic disclosed intense alveolar damage and hemorrhage and severe bronchiolitis. A co-infection with cytomegalovirus was described in the pregnant patient.

Objective: To verify serum procalcitonin levels of patients with acute respiratory failure secondary to influenza A (H1N1) upon their admission to the Intensive Care Unit and to compare these results to values found in patients with sepsis and trauma admitted to the same unit. Methods: Analysis of records of patients infected with influenza A (H1N1) and respiratory failure admitted to the General Intensive Care Unit during in a period of 60 days. The values of serum procalcitonin and clinical and laboratory data were compared to those of all patients admitted with sepsis or trauma in the previous year. Results: Among patients with influenza A (H1N1) (n = 16), the median serum procalcitonin level upon admission was 0.11 ng/mL, lower than in the sepsis group (p < 0.001) and slightly lower than in trauma patients. Although the mean values were low, serum procalcitonin was a strong predictor of hospital mortality in patients with influenza A (H1N1). Conclusion: Patients with influenza A (H1N1) with severe acute respiratory failure presented with low serum procalcitonin values upon admission, although their serum levels are predictors of hospital mortality. The kinetics study of this biomarker may be a useful tool in the management of this group of patients.