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LETTER TO THE EDITOR
Year : 2011  |  Volume : 6  |  Issue : 4  |  Page : 241-242
Acute respiratory damage in patients with pandemic 2009 AH1N1 influenza: Pulmonary function testing a year after?


Department of Intensive Care Medicine, Centre d'Assistance Médicale Urgente et de Réanimation, 50 Rue Abou Kacem Chebbi, 1008 Montfleury Tunis, Tunisia

Date of Web Publication12-Sep-2011

Correspondence Address:
Nozha Brahmi
Department of Intensive Care Medicine, Centre d'Assistance Médicale Urgente et de Réanimation, 50 Rue Abou Kacem Chebbi, 1008 Montfleury Tunis
Tunisia
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DOI: 10.4103/1817-1737.84782

PMID: 21977073

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How to cite this article:
Brahmi N, M'rad A, El Ghord H, Kouraichi N, Thabet H, Amamou M. Acute respiratory damage in patients with pandemic 2009 AH1N1 influenza: Pulmonary function testing a year after?. Ann Thorac Med 2011;6:241-2

How to cite this URL:
Brahmi N, M'rad A, El Ghord H, Kouraichi N, Thabet H, Amamou M. Acute respiratory damage in patients with pandemic 2009 AH1N1 influenza: Pulmonary function testing a year after?. Ann Thorac Med [serial online] 2011 [cited 2019 Oct 19];6:241-2. Available from: http://www.thoracicmedicine.org/text.asp?2011/6/4/241/84782


Sir,

In H1N1 severe acute respiratory distress syndrome (ARDS) cases, native lung function is usually so compromised with resultant severe hypoxemia, [1],[2],[3] that the overall case fatality ratio has been estimated at <0.5%, with a short disease course and good prognosis. [2],[3] The lung function in survivors of acute lung injury returns to normal over six to twelve months independently, on etiology. [4] We report a long-term respiratory functional exploration by a spirometer type Sensor Medics in six-survival patients among eighteen suffering from acute respiratory distress after the pandemic 2009 H1N1 influenza, requiring protective mechanical ventilation. They were strongly affected with a mean pulmonary compliance of 22.6 ± 3.9 ml/ cm H2 O (range, 18 to 28), a PaO 2 /FiO 2 of 109 ± 29 mmHg and a chest computed tomography (CT) showing ground glass opacities corresponding to areas of alveolar edema and necropsy, with pulmonary lesions in favor of fibrosis in one patient. No pulmonary co- or secondary infection was retained on admission and during ICU stay. The evolution was gradually favorable, which allowed mechanical weaning with a delay of 17 ± 9 days (range, 8 to 30). In the substantial proportion of mechanically ventilated patients with slow recovery, the chest CT realized between three and six months was normal in five patients, and showed a persistence of bilateral and diffuse interstitial infringement in the patient who developed early pulmonary fibrosis. The lung function testing realized between six months and a year was within normal limits in all patients, even in those developing pulmonary fibrosis [Figure 1]. According to literature data, all that we might know is the recuperation ad integrum of the respiratory function within a six- month- to- a- one year period, after an acute respiratory failure, independent from the virus AH1N1. [4] As a matter of fact, all the literature data published since April 2009 concerning secondary acute respiratory distress were interested in the predictable, clinical, and epidemiological aspects within the short-term. [5],[6] No follow-up in the long term that includes a research study on the respiratory function has been subject for publication up to now. Our results match with the study of Suchyta, [4] with recuperation of a normal respiratory function, as witnessed in the forced results of the spirometer and in the movable volumes. This makes one believe that the evolution of ARDS due to the AH1N1 virus is always quite favorable if the patient manages to survive the initial phase of the disease; the patients' respiratory functional follow-up being proof of the total recovery. As such, facing reduced numbers and surveillance on a larger scale would be desirable so as to justify these results.
Figure 1: Pulmonary function test in patient who developed early pulmonary fibrosis

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   References Top

1.Chowell G, Bertozzi SM, Colchero MA, Lopez- Gatell H, Alpuche-Aranda C, Hernandez M, et al. Severe respiratory disease concurrent with the circulation of H1N1 influenza. N Engl J Med 2009;61:674-9.  Back to cited text no. 1
    
2.Dominguez-Cherti G, Lapinsky SE, Macias AE, Printo R, Espinosa-Perez L, de la Torre A, et al. Critically ill patients with 2009 influenza A (H1N1) in Mexico. JAMA 2009;302:1880-7.  Back to cited text no. 2
    
3.Kumar A, Zarychanski R, Pinto R, Cook DJ, Marshall J, Lacroix J, et al. Critically ill patients with 2009 influenza A (H1N1) infection in Canada. JAMA 2009;302:1872-9.  Back to cited text no. 3
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4.Suchyta MR, Elliott CG, Jensen Rl, Crapo RO. Predicting the presence of pulmonary function impairment in adult respiratory distress syndrome survivors. Respiration 1993;60:103-8.  Back to cited text no. 4
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5.Petrosillo N, Di Bella S, Drapeau CM, Grilli E. The novel influenza A (H1N1) virus pandemic: An update. Ann Thorac Med 2009;4:163-72.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.Ramsey C, Kumar A. H1N1: Viral pneumonia as a cause of acute respiratory distress syndrome. Curr Opin Crit Care 2011;17:64-71.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  


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