Long-term Outcomes of Pandemic 2009 Influenza A(H1N1)-Associated Severe ARDS


      No data on long-term outcomes of survivors of 2009 influenza A(H1N1) (A[H1N1])-associated ARDS are available. The objective of this study was to compare the 1-year outcomes of survivors of A(H1N1)-associated ARDS, according to use or no use of extracorporeal lung assist (ECLA), using its need as an ARDS severity surrogate.


      Survivors of ARDS (12 with ECLA use vs 25 without, corresponding to 75% and 54% of the eligible patients for each group, respectively) selected from the Réseau Européen de Ventilation Artificielle (REVA) registry had previously been healthy, with only pregnancy and/or moderate obesity (BMI ≤ 35 kg/m2) as known risk factors for A(H1N1) infection. Lung function and morphology, health-related quality of life (HRQoL), and psychologic impairment were evaluated.


      At 1 year post-ICU discharge for the ECLA and no-ECLA groups, respectively, 50% and 40% reported significant exertion dyspnea, 83% and 64% had returned to work, and 75% and 64% had decreased diffusion capacity across the blood-gas barrier, despite their near-normal and similar lung function test results. For both groups, exercise test results showed diminished but comparable exercise capacities, with similar alveolar-arterial oxygen gradients at peak exercise, and CT scans showed minor abnormal findings. HRQoL assessed by the 36-Item Short-Form Health Survey was poorer for both groups than for a sex- and age-matched general population group, but without between-group differences. ECLA and no-ECLA group patients, respectively, had symptoms of anxiety (50% and 56%) and depression (28% and 28%) and were at risk for posttraumatic stress disorder (41% and 44%).


      One year post-ICU discharge, a majority of survivors of A(H1N1)-associated ARDS had minor lung disabilities with diminished diffusion capacities across the blood-gas barrier, and most had psychologic impairment and poorer HRQoL than a sex- and age-matched general population group. ECLA and no-ECLA group patients had comparable outcomes.

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        • Hert R
        • Albert RK
        Sequelae of the adult respiratory distress syndrome.
        Thorax. 1994; 49: 8-13
        • Schelling G
        • Stoll C
        • Haller M
        • et al.
        Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome.
        Crit Care Med. 1998; 26: 651-659
        • Herridge MS
        • Cheung AM
        • Tansey CM
        • Canadian Critical Care Trials Group
        • et al.
        One-year outcomes in survivors of the acute respiratory distress syndrome.
        N Engl J Med. 2003; 348: 683-693
        • Combes A
        • Costa MA
        • Trouillet JL
        • et al.
        Morbidity, mortality, and quality-of-life outcomes of patients requiring >or=14 days of mechanical ventilation.
        Crit Care Med. 2003; 31: 1373-1381
        • Cheung AM
        • Tansey CM
        • Tomlinson G
        • et al.
        Two-year outcomes, health care use, and costs of survivors of acute respiratory distress syndrome.
        Am J Respir Crit Care Med. 2006; 174: 538-544
        • Adhikari NK
        • McAndrews MP
        • Tansey CM
        • et al.
        Self-reported symptoms of depression and memory dysfunction in survivors of ARDS.
        Chest. 2009; 135: 678-687
        • Bautista E
        • Chotpitayasunondh T
        • Gao Z
        • Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza
        • et al.
        Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection.
        N Engl J Med. 2010; 362: 1708-1719
        • Davies A
        • Jones D
        • Bailey M
        • Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators
        • et al.
        Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome.
        JAMA. 2009; 302: 1888-1895
        • Lindén VB
        • Lidegran MK
        • Frisén G
        • Dahlgren P
        • Frenckner BP
        • Larsen F
        ECMO in ARDS: a long-term follow-up study regarding pulmonary morphology and function and health-related quality of life.
        Acta Anaesthesiol Scand. 2009; 53: 489-495
        • Fuhrman C
        • Bonmarin I
        • Bitar D
        • et al.
        Adult intensive-care patients with 2009 pandemic influenza A(H1N1) infection.
        Epidemiol Infect. 2010; 139: 1202-1209
        • Mercat A
        • Richard JC
        • Combes A
        • et al.
        Acute respiratory distress syndrome due to influenza A (H1N1)2009: recommendations for respiratory management.
        (Accessed July 11, 2012)
        • The Acute Respiratory Distress Syndrome Network
        Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.
        N Engl J Med. 2000; 342: 1301-1308
        • Bernard GR
        • Artigas A
        • Brigham KL
        • et al.
        The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination.
        Am J Respir Crit Care Med. 1994; 149: 818-824
        • McCabe WR
        • Jackson GG
        Gram-negative bacteremia.
        Arch Intern Med. 1962; 110: 847-855
        • Vincent JL
        • Moreno R
        • Takala J
        • et al.
        The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine.
        Intensive Care Med. 1996; 22: 707-710
        • Moreno RP
        • Metnitz PG
        • Almeida E
        • SAPS 3 Investigators
        • et al.
        SAPS 3—from evaluation of the patient to evaluation of the intensive care unit. Part 2: development of a prognostic model for hospital mortality at ICU admission.
        Intensive Care Med. 2005; 31: 1345-1355
        • McHorney CA
        • Ware Jr, JE
        • Lu JF
        • Sherbourne CD
        The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups.
        Med Care. 1994; 32: 40-66
        • Zigmond AS
        • Snaith RP
        The hospital anxiety and depression scale.
        Acta Psychiatr Scand. 1983; 67: 361-370
        • Stoll C
        • Kapfhammer HP
        • Rothenhäusler HB
        • et al.
        Sensitivity and specificity of a screening test to document traumatic experiences and to diagnose post-traumatic stress disorder in ARDS patients after intensive care treatment.
        Intensive Care Med. 1999; 25: 697-704
        • Mahler DA
        • Rosiello RA
        • Harver A
        • Lentine T
        • McGovern JF
        • Daubenspeck JA
        Comparison of clinical dyspnea ratings and psychophysical measurements of respiratory sensation in obstructive airway disease.
        Am Rev Respir Dis. 1987; 135: 1229-1233
        • Ingenbleek Y
        • Van Den Schrieck HG
        • De Nayer P
        • De Visscher M
        Albumin, transferrin and the thyroxine-binding prealbumin/retinol-binding protein (TBPA-RBP) complex in assessment of malnutrition.
        Clin Chim Acta. 1975; 63: 61-67
        • Bernstein L
        • Pleban W
        Prealbumin in nutrition evaluation.
        Nutrition. 1996; 12: 255-259
        • Shenkin A
        Serum prealbumin: is it a marker of nutritional status or of risk of malnutrition?.
        Clin Chem. 2006; 52: 2177-2179
        • Hansen JE
        • Sue DY
        • Wasserman K
        Predicted values for clinical exercise testing.
        Am Rev Respir Dis. 1984; 129: S49-S55
        • Herridge MS
        • Tansey CM
        • Matté A
        • Canadian Critical Care Trials Group
        • et al.
        Functional disability 5 years after acute respiratory distress syndrome.
        N Engl J Med. 2011; 364: 1293-1304
        • McHugh LG
        • Milberg JA
        • Whitcomb ME
        • Schoene RB
        • Maunder RJ
        • Hudson LD
        Recovery of function in survivors of the acute respiratory distress syndrome.
        Am J Respir Crit Care Med. 1994; 150: 90-94
        • Davidson TA
        • Caldwell ES
        • Curtis JR
        • Hudson LD
        • Steinberg KP
        Reduced quality of life in survivors of acute respiratory distress syndrome compared with critically ill control patients.
        JAMA. 1999; 281: 354-360
        • Angus DC
        • Musthafa AA
        • Clermont G
        • et al.
        Quality-adjusted survival in the first year after the acute respiratory distress syndrome.
        Am J Respir Crit Care Med. 2001; 163: 1389-1394
        • Hopkins RO
        • Weaver LK
        • Collingridge D
        • Parkinson RB
        • Chan KJ
        • Orme Jr, JF
        Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome.
        Am J Respir Crit Care Med. 2005; 171: 340-347
      1. Bienvenu OJ, Colantuoni E, Mendez-Tellez PA, et al. Depressive symptoms and impaired physical function after acute lung injury: a 2-year longitudinal study [published online ahead of print December 8, 2011]. Am J Respir Crit Care Med. doi:10.1164/rccm.201103-0503OC.

        • Dowdy DW
        • Eid MP
        • Dennison CR
        • et al.
        Quality of life after acute respiratory distress syndrome: a meta-analysis.
        Intensive Care Med. 2006; 32: 1115-1124
        • Peek GJ
        • Mugford M
        • Tiruvoipati R
        • CESAR trial collaboration
        • et al.
        Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial.
        Lancet. 2009; 374: 1351-1363
        • De Jonghe B
        • Sharshar T
        • Lefaucheur JP
        • Groupe de Réflexion et d'Etude des Neuromyopathies en Réanimation
        • et al.
        Paresis acquired in the intensive care unit: a prospective multicenter study.
        JAMA. 2002; 288: 2859-2867
        • Bittner EA
        • Martyn JA
        • George E
        • Frontera WR
        • Eikermann M
        Measurement of muscle strength in the intensive care unit.
        Crit Care Med. 2009; 37: S321-S330
        • Papazian L
        • Forel JM
        • Gacouin A
        • ACURASYS Study Investigators
        • et al.
        Neuromuscular blockers in early acute respiratory distress syndrome.
        N Engl J Med. 2010; 363: 1107-1116

      Linked Article

      • The Homogeneous and Robust Clinical Phenotype of Severe Lung Injury
        CHESTVol. 142Issue 3
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          Acute-onset severe lung injury, regardless of etiology or associated risk factors, is universally recognized in terms of its sameness. Patients with this condition share many similarities, including younger age, few comorbidities, recovery of lung function in those without preexisting lung disease, ICU-acquired weakness (ICUAW), and neuropsychologic dysfunction. These patients also share resilience and recovery from a profound, multisystem, and exuberant inflammatory response. These outcomes are robust over time and across different countries and investigators.
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