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Failure of combination oral oseltamivir and inhaled zanamivir antiviral treatment in ventilator- and ECMO-treated critically ill patients with pandemic influenza A (H1N1)v
- Source :
- Petersen, E, Keld, D B, Ellermann-Eriksen, S, Gubbels, S, Ilkjær, S, Jensen-Fangel, S & Lindskov, C 2011, ' Failure of combination oral oseltamivir and inhaled zanamivir antiviral treatment in ventilator-and ECMO-treated critically ill patients with pandemic influenza A (H1N1)v ', Scandinavian Journal of Infectious Diseases, vol. 43, no. 6-7, pp. 495-503 . https://doi.org/10.3109/00365548.2011.556144
- Publication Year :
- 2011
-
Abstract
- Objective: The objective of this study was to describe the clinical course of severe and complicated pandemic (H1N1)v infection treated with oral oseltamivir and inhaled zanamivir in a series of intensive care patients. Methods: We investigated a case series of patients with respiratory failure and a positive (H1N1)v real-time reverse transcriptase polymerase chain reaction (rRT-PCR). Treatment consisted of oseltamivir tablets 75 mg × 4 daily in a nasogastric tube plus zanamivir intravenous (i.v.) solution 25 mg × 4 daily as inhalation. Ventilator inspiratory plateau airway pressure in the ventilator was kept below 30 cmH(2)O, PaO(2) above 8 kPa and pH above 7.30. If this could not be achieved, inhalational nitric oxide (NO) was added or extracorporeal membrane oxygenation (ECMO) was initiated. Results: Twenty-one patients were admitted, with a median age of 50 y (range 6-69 y). Five patients (23.8%) died in the intensive care unit (ICU) and 1 patient died 2 weeks after ICU discharge. Nine patients received ECMO treatment, of whom 3 died during ECMO (33.3%; 3/9) and 1 at 2 weeks after. The mortality in patients not receiving ECMO treatment was 16.6% (2/12). Sixteen patients (76%) were influenza PCR-positive on day 7 after the start of antiviral treatment. Irreversible presumed lung fibrosis complicated with pneumothorax was common. A high Murray score at admission was significantly associated with a fatal outcome. Conclusions: The mortality in these patients was high despite combined antiviral treatment with oseltamivir and zanamivir. Patients shed virus for a long time despite intensive therapy. Optimal management of patients with bilateral pneumonia and respiratory failure caused by (H1N1)v still needs to be determined.
- Subjects :
- Microbiology (medical)
Adult
Male
Oseltamivir
medicine.medical_specialty
Time Factors
medicine.drug_class
medicine.medical_treatment
Critical Illness
Administration, Oral
Antiviral Agents
law.invention
chemistry.chemical_compound
Zanamivir
Extracorporeal Membrane Oxygenation
Influenza A Virus, H1N1 Subtype
law
Intensive care
Administration, Inhalation
Influenza, Human
Extracorporeal membrane oxygenation
medicine
Humans
Treatment Failure
Child
Aged
General Immunology and Microbiology
Inhalation
Neuraminidase inhibitor
business.industry
General Medicine
Middle Aged
Intensive care unit
Respiration, Artificial
Surgery
respiratory tract diseases
Virus Shedding
Infectious Diseases
Respiratory failure
chemistry
Anesthesia
Drug Therapy, Combination
Female
business
medicine.drug
Subjects
Details
- ISSN :
- 16511980
- Volume :
- 43
- Issue :
- 6-7
- Database :
- OpenAIRE
- Journal :
- Scandinavian journal of infectious diseases
- Accession number :
- edsair.doi.dedup.....a93fea903c7a91e9bc19d6a1a4cd36d0