Influenza A (H1N1) vs non-H1N1 ARDS: Analysis of clinical course

Töpfer, Lars; Menk, Mario; Weber‐Carstens, Steffen; Spies, Claudia; Wernecke, Klaus‐Dieter; Uhrig, Alexander; Lojewski, Christian; Jörres, Achim; Deja, Maria

doi:10.1016/j.jcrc.2013.12.013

Cited by 43 publications

(33 citation statements)

References 30 publications

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“…(9,18,21) The SOFA scores of our patients were higher than those reported in a few recently published studies, (11,18) however, the PaO 2 /FiO 2 ratio and lung injury score were similar to those in other reported studies. (10,17,18) ECMO was started within 48 hours of mechanical ventilation in nine patients, similar to other studies. (11,17,18,21) …”

Section: Discussionsupporting

confidence: 74%

Extracorporeal membrane oxygenation in acute respiratory distress syndrome due to influenza A (H1N1)pdm09 pneumonia. A single-center experience during the 2013-2014 season

Menon¹,

Pérez-Vélez²,

Wheeler³

et al. 2017

Revista Brasileira De Terapia Intensiva

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ObjectiveThis report aimed to describe the outcomes of the patients with severe H1N1 associated acute respiratory distress syndrome who were treated with extracorporeal membrane oxygenation therapy.MethodsThis retrospective review analyzed a single-center cohort of adult patients with H1N1-related acute respiratory distress syndrome who were managed with veno-venous extracorporeal membrane oxygenation during the winter of 2013/2014.ResultsA total of 10 patients received veno-venous extracorporeal membrane oxygenation for H1N1 influenza between January 2013 and March 2014. Seven patients were transferred to our center for extracorporeal membrane oxygenation consideration (all within 72 hours of initiating mechanical ventilation). The median patient age was forty years, and 30% were female. The median arterial oxygen partial pressure to fraction of inspired oxygen ratio was 62.5, and the median RESP score was 6. Three patients received inhaled nitric oxide, and four patients were proned as rescue therapy before extracorporeal membrane oxygenation was initiated. The median duration of mechanical ventilation was twenty-two days (range, 14 - 32). The median length of stay in the intensive care unit was twenty-seven days (range, 14 - 39). The median hospital length of stay was 29.1 days (range, 16.0 - 46.9). Minor bleeding complications occurred in 6 of 10 patients. Eight of the ten patients survived to hospital discharge.ConclusionThe survivors were relatively young and discharged with good functional status (i.e., enhancing quality-adjusted life-years-saved). Our experience shows that even a relatively new extracorporeal membrane oxygenation program can play an important role in that capacity and provide excellent outcomes for the sickest patients.

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Section: Discussionsupporting

confidence: 74%

Extracorporeal membrane oxygenation in acute respiratory distress syndrome due to influenza A (H1N1)pdm09 pneumonia. A single-center experience during the 2013-2014 season

Menon¹,

Pérez-Vélez²,

Wheeler³

et al. 2017

Revista Brasileira De Terapia Intensiva

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“…The study reported that HIF-1α was upregulated in the lungs of H5N1-infected cynomolgus macaques, which suggested that measurement of HIF-1α expression could be used as a prognostic biomarker in severe respiratory infections. 29 Considering hypoxia occurs in lung tissue with severe inflammation caused by influenza virus infection, 30, 31 a potential explanation for the increased levels of HIF-1α observed in vivo is that they may be induced by hypoxia. 32, 33, 34 In our study of A549 and THP-1 cells cultured under normal oxygen concentrations, H1N1 infection did not stimulate the expression of HIF-1α, but it did promote the nuclear translocation of HIF-1α.…”

Section: Discussionmentioning

confidence: 99%

Nuclear translocation of HIF-1α induced by influenza A (H1N1) infection is critical to the production of proinflammatory cytokines

Guo

Zhu

Zhang

et al. 2017

Emerging Microbes & Infections

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Infection with the influenza A (H1N1) virus is a major challenge for public health because it can cause severe morbidity and even mortality in humans. The over-secretion of inflammatory cytokines (cytokine storm) is considered to be a key contributor to the severe pneumonia caused by H1N1 infection. It has been reported that hypoxia-inducible factor 1-alpha (HIF-1α) is associated with the production of proinflammatory molecules, but whether HIF-1α participates in the acute inflammatory responses against H1N1 infection is still unclear. To investigate the role of HIF-1α in H1N1 infection, the expression and nuclear translocation of HIF-1α in A549 and THP-1 cell lines infected with H1N1 virus were observed. The results showed that without altering the intracellular mRNA or protein expression of HIF-1α, H1N1 infection only induced nuclear translocation of HIF-1α under normal oxygen concentrations. The use of 2-methoxyestradiol (2ME2), a HIF-1α inhibitor that blocks HIF-1α nuclear accumulation, in H1N1-infected cells decreased the mRNA and protein expression of tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-6 and increased the levels of IL-10. In contrast, H1N1-infected cells under hypoxic conditions had increased HIF-1α nuclear accumulation, increased expression of TNF-α and IL-6 and decreased levels of IL-10. In conclusion, our data implied that in vitro H1N1 infection induced nuclear translocation of HIF-1α without altering the expression of HIF-1α, which may promote the secretion of proinflammatory cytokines during H1N1 infection.

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“…Animal models have demonstrated that H1N1 influenza infection is associated with an early and sustained inflammatory response (31), with evidence that lung injury caused by the virus increases susceptibility to further insult by bacterial superinfection (32). It has also been shown that a mutation in the hemagglutinin gene of H1N1 influenza leads to its ability to infect ciliated bronchial cells of the lower respiratory tract, and this cell tropism has the potential to increase the severity of illness (33-35). In contrast, EV-D68 has a higher affinity for receptors of the upper respiratory tract than the lower respiratory tract (36).…”

Section: Discussionmentioning

confidence: 99%

Enterovirus D68 in Critically Ill Children: A Comparison With Pandemic H1N1 Influenza*

Rao

Messacar

Torok

et al. 2016

Pediatric Critical Care Medicine

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Objective In 2014, the US experienced an outbreak of enterovirus D68 (EV-D68) associated with severe respiratory illness. The clinical characteristics associated with severe illness from EV-D68 during this outbreak compared with the 2009 H1N1 influenza virus outbreak are unknown. Design and Setting In this retrospective cohort study, we characterized the clinical features of children with EV-D68 admitted to the pediatric ICU between August 1-November 1, 2014 and compared them with critically-ill children infected with H1N1 influenza during the pandemic admitted between May 1, 2009-January 31, 2010. Patients pediatric ICU patients Interventions none Measurements and Main Results Ninety-seven severely-ill children with EV-D68 infections were compared with 68 children infected with H1N1 influenza during the 2009 pandemic. Children with EV-D68 were more likely to have asthma (62% vs 23%, P< 0.001) and present with reactive airway disease exacerbations, with greater receipt of albuterol (94% vs 49%) and steroids (89% vs 40%, P< 0.0001 for both). While more children with EV-D68 were admitted to the ICU compared with H1N1 influenza, they had a shorter hospital length of stay (4 vs 7 days, P< 0.0001), with lower intubation rates (7% vs 44%), vasopressor use (3% vs 32%), ARDS (3% vs 24%), shock (0% vs 16%) and death (0% vs 12 %, P< 0.05 for all). Compared with children with other enteroviruses and rhinoviruses, children with EV-D68 were more likely to have a history of asthma (64% vs 45%) or multiple prior wheezing episodes (54% vs 34%, P < 0.01 for both). Conclusions Critically-ill children with EV-D68 were more likely to present with reactive airway disease exacerbations, whereas children with H1N1 influenza were more likely to present with pneumonia. Compared to the pandemic H1N1 influenza outbreak, the EV-D68 outbreak resulted in more children requiring admission to the ICU, but was associated with less severe outcomes.

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Influenza A (H1N1) vs non-H1N1 ARDS: Analysis of clinical course

Cited by 43 publications

References 30 publications

Extracorporeal membrane oxygenation in acute respiratory distress syndrome due to influenza A (H1N1)pdm09 pneumonia. A single-center experience during the 2013-2014 season

Extracorporeal membrane oxygenation in acute respiratory distress syndrome due to influenza A (H1N1)pdm09 pneumonia. A single-center experience during the 2013-2014 season

Nuclear translocation of HIF-1α induced by influenza A (H1N1) infection is critical to the production of proinflammatory cytokines

Enterovirus D68 in Critically Ill Children: A Comparison With Pandemic H1N1 Influenza*

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