Abstract:
Introduction: In oncological patients influenza may result in severe forms associated with high mortality (11-33% in solid
cancers, 23% in bone marrow transplant), one of them being acute respiratory distress syndrome (ARDS).
Objective: Evaluation of diagnostic, management and outcome particularities in ARDS AH1N1 influenza oncological patients.
Material and methods: The study enrolled all ARDS AH1N1 influenza patients, diagnosed and managed in ICU IRO Iași
in January-February 2018 during a hospital-acquired influenza outbreak. Analyzed parameters were patient related (cancer
type and treatment), influenza related (virus type and identification tests), ARDS related (severity, management, outcome).
Results: Out of 40 symptomatic or influenza contact asymptomatic patients, 21 tested positive for AH1N1 influenza virus, 9
out of them having ARDS managed in ICU. 5 pts presented severe ARDS in the context of post-therapeutic severe immune
compromise: 4 pts post-chemotherapy medullary aplasia for hemato-oncological disease and 1 pt post-radio/chemo/surgical
therapy for gynecological cancer. All received ventilatory support: 3 pts invasive ventilatory support in prone position (worst
PaO2/FiO2 29-46 mmHg, nonsurvivors), 2 pts non-invasive ventilatory support (worst PaO2/FiO2 54-94 mmHg, survivors).
After 25th Jan 2018 (first case) epidemiological alert and management were instituted, resulting in outbreak control on 23rd
Feb 2018 (last case).
Conclusions: In immuno-compromised oncological patients AH1N1 influenza may rapidly generate a hospital-acquired
outbreak and severe ARDS forms associated with high mortality. Early diagnostic and management are the most effective
strategies in reducing associated mortality and controlling influenza outbreak.
Description:
Grigore T. Popa University of Medicine and Pharmacy, Iași, România,
Regional Institute of Oncology, Iași, România, The 5th International Congress of the Society of Anesthesiology and Reanimatology of the Republic of Moldova, 16th Edition of the International Course of Guidelines and Protocols in Anesthesia, Intensive Care and Emergency Medicine, 28th Meeting of the European Society for Computing and Technology in Anesthesia and Intensive Care, September 27-29, 2018, Chisinau, the Republic of Moldova