AI Article Synopsis
- The study assessed the impact of SEMICYUC (2012) recommendations on severe influenza A patients by analyzing two distinct epidemic periods (2009-2011 and 2013-2015).
- It included 2,205 patients, revealing that the second period had older and more severely ill patients, with improvements in early diagnosis, corticosteroid usage, and vaccination rates.
- Although changes in treatment approaches were noted, there was no significant difference in mortality rates, indicating that while management has improved, further challenges remain, such as timely treatment and vaccination efforts.
Article Abstract
Objectives: To evaluate the impact of the recommendations of the SEMICYUC (2012) on severe influenza A.
Design: A prospective multicenter observational study was carried out.
Setting: ICU.
Patients: Patients infected with severe influenza A (H1N1) from the GETGAG/SEMICYUC registry.
Interventions: Analysis of 2 groups according to the epidemic period of the diagnosis (2009-2011; 2013-2015).
Variables: Demographic, temporal, comorbidities, severity, treatments, mortality, late diagnosis and place of acquisition.
Results: A total of 2,205 patients were included, 1,337 (60.6%) in the first period and 868 (39.4%) in the second one. Age and severity on admission were significantly greater in the second period, as well as co-infection. With regard to the impact of the recommendations, in the second period the diagnosis was established earlier (70.8 vs. 61.1%, P<.001), without changes in the start of treatment. Patients received less corticosteroid treatment (39.7 vs. 44.9%, P<.05), more NIMV was used (47.4 vs. 33.2%, P<.001) and more vaccination was made (11.1 vs. 1.7%, P<.001), without changes in mortality (24.2 vs. 20.7%). A decrease in nosocomial infection was also noted (9.8 vs. 16%, P<.001). Patients needed less MV with more days of ventilation, more vasopressor drug use and more ventral decubitus.
Conclusions: The management of patients with severe influenza A (H1N1) has changed over the years, though without changes in mortality. The recommendations of the SEMICYUC (2012) have allowed earlier diagnosis and improved corticosteroid use. Pending challenges are the delay in treatment, the vaccination rate and the use of NIMV.
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| http://dx.doi.org/10.1016/j.medin.2018.02.002 | DOI Listing |
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