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Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)v in Spain

Jordi Rello1*, Alejandro Rodríguez1, Pedro Ibañez2, Lorenzo Socias2, Javier Cebrian3, Asunción Marques4, José Guerrero5, Sergio Ruiz-Santana6, Enrique Marquez7, Frutos Del Nogal-Saez8, Francisco Alvarez-Lerma9, Sergio Martínez10, Miquel Ferrer11, Manuel Avellanas12, Rosa Granada13, Enrique Maraví-Poma14, Patricia Albert15, Rafael Sierra16, Loreto Vidaur17, Patricia Ortiz18, Isidro Prieto del Portillo19, Beatriz Galván20, Cristóbal León-Gil21 and the H1N1 SEMICYUC working group

Author Affiliations

1 Critical Care Department, Joan XXIII University Hospital, CIBERes Enfermedades Respiratorias. IISPV. Mallafre Guasch 4 (43007)Tarragona, Spain

2 Critical Care Department, Son Llatzer Hospital, Crta. Manacor Km 4, (07198) Palma de Mallorca, Spain

3 La Fe Hospital, CIBERES, Av. Campanar 21 (46009) Valencia, Spain

4 De la Ribera Hospital. Crta. de Corbera Km 1 (46600) Alzira, Valencia, Spain

5 Gregorio Marañón Hospital, CIBERES, Calle Doctor Esquerdo 46 (28004) Madrid, Spain

6 Dr. Negrín Hospital, Barranco de la Ballena s/n (35010) Las Palmas de Gran Canarias, Spain

7 Infanta Elena, C/Red Corp, J. Andalucía s/n, (21700) Huelva, Spain

8 Severo Ochoa Hospital, Avd. de Orellana s/n (28911) Leganés, Madrid, Spain

9 Del Mar Hospital, CIBERES, Passeig Maritim 25-29 (08003) Barcelona, Spain

10 Insular Hospital de Gran Canarias, Carretera del Sur s/n (35016) Las Palmas de Gran Canarias, Spain

11 Clinic Hospital, IDIBAPS, CIBERES Enfermedades Respiratorias, C/Villarroel 170 (08036) Barcelona, Spain

12 San Jorge General Hospital, Av. Martínez de Velazco 36 (22004) Huesca, Spain

13 Bellvitge University Hospital, CIBERES, Feixa Llarga s/n (08907) Barcelona, Spain

14 Virgen del Camino Hospital, C/de Irunlarrea 4 (31008) Navarra, Spain

15 Hospital del Sureste, Ronda del Sur 10 (28500) Arganda del Rey, Madrid, Spain

16 Puerta del Mar Hospital, Avda Ana de Viya 21 (11009) Cádiz, Spain

17 Hospital Donostia, Paseo Dr. José Beguiristain s/n (20014) Donostia, San Sebastian, Spain

18 Josep Trueta University Hospital, Avda. França s/n (17007) Girona, Spain

19 Ramón y Cajal University Hospital, Ctra. De Colmenar Viejo Km 9,100 (28034) Madrid, Spain

20 La Paz University Hospital, P de la Castellana 261 (28046) Madrid, Spain

21 Hospital Nuestra Señora de Valme, Ctra. Cádiz-Bellavist Km 548 (41014) Sevilla, Spain

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Critical Care 2009, 13:R148  doi:10.1186/cc8044

See related commentary by Opal, and see related letters by Alonso-Tarrés et al.,, Yeung et al.,, Gimeno and Navarro,, Ñamendys-Silva et al., and Winck and Marinho,

Published: 11 September 2009



Patients with influenza A (H1N1)v infection have developed rapidly progressive lower respiratory tract disease resulting in respiratory failure. We describe the clinical and epidemiologic characteristics of the first 32 persons reported to be admitted to the intensive care unit (ICU) due to influenza A (H1N1)v infection in Spain.


We used medical chart reviews to collect data on ICU adult patients reported in a standardized form. Influenza A (H1N1)v infection was confirmed in specimens using real-time reverse transcriptase-polymerase-chain-reaction (RT PCR) assay.


Illness onset of the 32 patients occurred between 23 June and 31 July, 2009. The median age was 36 years (IQR = 31 - 52). Ten (31.2%) were obese, 2 (6.3%) pregnant and 16 (50%) had pre-existing medical complications. Twenty-nine (90.6%) had primary viral pneumonitis, 2 (6.3%) exacerbation of structural respiratory disease and 1 (3.1%) secondary bacterial pneumonia. Twenty-four patients (75.0%) developed multiorgan dysfunction, 7 (21.9%) received renal replacement techniques and 24 (75.0%) required mechanical ventilation. Six patients died within 28 days, with two additional late deaths. Oseltamivir administration delay ranged from 2 to 8 days after illness onset, 31.2% received high-dose (300 mg/day), and treatment duration ranged from 5 to 10 days (mean 8.0 ± 3.3).


Over a 5-week period, influenza A (H1N1)v infection led to ICU admission in 32 adult patients, with frequently observed severe hypoxemia and a relatively high case-fatality rate. Clinicians should be aware of pulmonary complications of influenza A (H1N1)v infection, particularly in pregnant and young obese but previously healthy persons.