Patients with influenza A (H1N1)pdm09 admitted to the ICU. Impact of the recommendations of the SEMICYUC

Med Intensiva (Engl Ed). 2018 Nov;42(8):473-481. doi: 10.1016/j.medin.2018.02.002. Epub 2018 Mar 17.
[Article in English, Spanish]


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.

Keywords: Critically illness; Enfermedad crítica; Infección por virus influenza A (H1N1)pdm09; Influenza A (H1N1)pdm09 virus infection; Intensive Care Unit; Manejo terapéutico; Mortalidad; Mortality; Outcome; Pronóstico; Therapeutic management; Unidad de Cuidados Intensivos.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Age Distribution
  • Antiviral Agents / therapeutic use
  • Bacterial Infections / epidemiology
  • Combined Modality Therapy
  • Comorbidity
  • Cross Infection / epidemiology
  • Delayed Diagnosis
  • Disease Outbreaks*
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Influenza A Virus, H1N1 Subtype*
  • Influenza Vaccines
  • Influenza, Human / drug therapy
  • Influenza, Human / epidemiology*
  • Influenza, Human / therapy
  • Influenza, Human / virology
  • Intensive Care Units / statistics & numerical data*
  • Male
  • Middle Aged
  • Practice Guidelines as Topic*
  • Procedures and Techniques Utilization
  • Prone Position
  • Prospective Studies
  • Registries
  • Respiration, Artificial / statistics & numerical data
  • Severity of Illness Index
  • Spain / epidemiology
  • Vaccination / statistics & numerical data
  • Vasoconstrictor Agents / therapeutic use


  • Adrenal Cortex Hormones
  • Antiviral Agents
  • Influenza Vaccines
  • Vasoconstrictor Agents