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Gripe A (H1N1)v pandémica en UCI: ¿qué hemos aprendido? | Archivos de Bronconeumología
Archivos de Bronconeumología Archivos de Bronconeumología
Arch Bronconeumol 2010;46 Supl 2:24-31 - Vol. 46 DOI: 10.1016/S0300-2896(10)70017-X
Gripe A (H1N1)v pandémica en UCI: ¿qué hemos aprendido?
Pandemic influenza A (H1N1)v in the intensive care unit: what have we learned?
Alejandro Rodrígueza, Thiago Lisboaa,b, Jordi Relloc,, , el GETGAG/SEMICYUC (Grupo Español de Trabajo de Gripe A Grave/SEMICYUC)
a Servicio de Medicina Intensiva, IISPV, CIBER Enfermedades Respiratorias, Hospital Universitario Joan XXIII, Tarragona, España
b Servicio de Medicina Intensiva, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil
c Unidad de Cuidados Intensivos, Hospital Vall d’Hebron, Barcelona, España
Resumen

Las características de la gripe pandémica 2009 son diferentes de las de la gripe estacional. En Australia- Nueva Zelanda (ANZIC) se multiplicaron por 15 los ingresos en la unidad de cuidados intensivos (UCI) en el invierno austral. Se comparan las características de la serie española de los primeros ingresos en UCI en julio con las series publicadas en Canadá y ANZIC hasta octubre de 2009. A diferencia de lo observado en España, sólo la mitad de los ingresos en Canadá y ANZIC se debió a neumonía viral primaria, mientras que la neumonía bacteriana fue más frecuente en los primeros. En todas las series, los jóvenes, muchos de los cuales no tenían comorbilidad, fueron la población más afectada. La obesidad, la patología pulmonar crónica, el embarazo y la cardiopatía fueron las comorbilidades más frecuentes. El diagnóstico mediante rt-PCR puede presentar un 10% de falsos negativos. El shock y la insuficiencia renal aguda fueron más frecuentes en la serie española. El 10-30% de los afectados requieren ingreso a UCI y 6 de cada 10 ventilación mecánica (VM), con una alta frecuencia de fracaso de la ventilación no invasiva (75%). La mortalidad fue similar entre las series (14-25%), aunque mayor en los pacientes que requieren VM (30%). La administración precoz (< 48 h de inicio de los síntomas) de oseltamvir se ha asociado a una mejor evolución. Por ello, su administración precoz en pacientes con factores de riesgo, o en quienes aun sin ellos presentan signos de progresión clínica, podría reducir el ingreso en la UCI y la mortalidad.

Abstract

The characteristics of pandemic influenza 2009 differ from those of seasonal influenza. In Australia-New Zealand the number of admissions to the intensive care unit (ICU) increased by 15-fold in the southern winter. We compared the characteristics of the Spanish series of the first ICU admissions in July with those of series published in Canada and Australia-New Zealand up to October 2009. Unlike the situation in Spain, only half the admissions in Canada and Australia-New Zealand were due to primary viral pneumonia but bacterial pneumonia was much more frequent. In all series, young people, many of whom had no comborbidities, were the most frequently affected population. The most common comorbidities were obesity, chronic pulmonary disease, pregnancy and heart disease. Diagnosis through reverse-transcriptase polymerase chain reaction can have a false-negative rate of 10%. Shock and acute renal insufficiency were more frequent in the Spanish series. A total of 10-30% of patients required ICU admission and 6 of 10 patients required mechanical ventilation with a high frequency of failure of non-invasive ventilation (75%). Mortality was similar among the series (14-25%) but was higher in patients requiring mechanical ventilation (30%). Early oseltamivir administration (< 48h after symptom onset) has been associated with better outcome. Therefore, early administration of this drug in patients with risk factors or those who, although free from risk factors, show clinical progression, could reduce ICU admissions and mortality.

Keywords
Influenza A, Pandemic influenza 2009 (H1N1), Primary viral pneumonia, Acute respiratory distress syndrome
Palabras clave
Gripe A, Gripe pandémica 2009 (H1N1), Neumonía viral primaria, ARDS
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Arch Bronconeumol 2010;46 Supl 2:24-31 - Vol. 46 DOI: 10.1016/S0300-2896(10)70017-X