Severe influenza: Overview in critically ill patients

Cristina Sarda, Pedro Palma, Jordi Rello

Research output: Contribution to journalReview article

Abstract

Purpose of reviewOverview of influenza infection, focusing on outcome and complications in critically ill patients. We also discuss relevant elements in immunopathogenesis and their role as predictors of severity.Recent findingsPandemic influenza A (H1N1) virus circulates seasonally and remains the predominant subtype among intensive care patients. Mortality in acute respiratory failure (ARF) is around 20%, independent of influenza subtypes. During severe infection, the imbalance between pro-inflammatory and anti-inflammatory molecules, such as Th1 and Th17 cytokines, is associated with complicated infections and mortality. Primary viral pneumonia presents in more than 70% of ICU influenza patients and more than 50% develop acute respiratory distress syndrome. Bacterial secondary infection occurs in 20% of severe cases and Streptococcus pneumoniae and Staphylococcus aureus remain the prevalent pathogens. Myocarditis and late-onset cardiovascular complications are associated with mortality. Antiviral therapy within 48 h after onset, avoidance of corticosteroids and rescue therapies for ARF or myocarditis, such as extracorporeal membrane oxygenation, improve survival.SummaryThe present review summarizes current knowledge on pathogenesis and clinical manifestations of severe influenza. Immunological dysfunction during viral infection correlates with severity and mortality among ICU patients. A theranostics strategy should be implemented to improve outcomes.

Original languageEnglish
Pages (from-to)449-457
Number of pages9
JournalCurrent Opinion in Critical Care
Volume25
Issue number5
DOIs
Publication statusPublished - Oct 1 2019
Externally publishedYes

Fingerprint

Critical Illness
Human Influenza
Mortality
Myocarditis
Respiratory Insufficiency
Infection
Viral Pneumonia
H1N1 Subtype Influenza A Virus
Extracorporeal Membrane Oxygenation
Influenza A virus
Adult Respiratory Distress Syndrome
Virus Diseases
Critical Care
Streptococcus pneumoniae
Coinfection
Bacterial Infections
Antiviral Agents
Staphylococcus aureus
Adrenal Cortex Hormones
Anti-Inflammatory Agents

Keywords

  • acute respiratory failure
  • myocarditis
  • primary viral pneumonia
  • secondary pneumonia
  • severe acute respiratory infection

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Severe influenza : Overview in critically ill patients. / Sarda, Cristina; Palma, Pedro; Rello, Jordi.

In: Current Opinion in Critical Care, Vol. 25, No. 5, 01.10.2019, p. 449-457.

Research output: Contribution to journalReview article

Sarda, Cristina ; Palma, Pedro ; Rello, Jordi. / Severe influenza : Overview in critically ill patients. In: Current Opinion in Critical Care. 2019 ; Vol. 25, No. 5. pp. 449-457.
@article{89d66e15a3f54021aeb4a40021fc9629,
title = "Severe influenza: Overview in critically ill patients",
abstract = "Purpose of reviewOverview of influenza infection, focusing on outcome and complications in critically ill patients. We also discuss relevant elements in immunopathogenesis and their role as predictors of severity.Recent findingsPandemic influenza A (H1N1) virus circulates seasonally and remains the predominant subtype among intensive care patients. Mortality in acute respiratory failure (ARF) is around 20{\%}, independent of influenza subtypes. During severe infection, the imbalance between pro-inflammatory and anti-inflammatory molecules, such as Th1 and Th17 cytokines, is associated with complicated infections and mortality. Primary viral pneumonia presents in more than 70{\%} of ICU influenza patients and more than 50{\%} develop acute respiratory distress syndrome. Bacterial secondary infection occurs in 20{\%} of severe cases and Streptococcus pneumoniae and Staphylococcus aureus remain the prevalent pathogens. Myocarditis and late-onset cardiovascular complications are associated with mortality. Antiviral therapy within 48 h after onset, avoidance of corticosteroids and rescue therapies for ARF or myocarditis, such as extracorporeal membrane oxygenation, improve survival.SummaryThe present review summarizes current knowledge on pathogenesis and clinical manifestations of severe influenza. Immunological dysfunction during viral infection correlates with severity and mortality among ICU patients. A theranostics strategy should be implemented to improve outcomes.",
keywords = "acute respiratory failure, myocarditis, primary viral pneumonia, secondary pneumonia, severe acute respiratory infection",
author = "Cristina Sarda and Pedro Palma and Jordi Rello",
year = "2019",
month = "10",
day = "1",
doi = "10.1097/MCC.0000000000000638",
language = "English",
volume = "25",
pages = "449--457",
journal = "Current Opinion in Critical Care",
issn = "1070-5295",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Severe influenza

T2 - Overview in critically ill patients

AU - Sarda, Cristina

AU - Palma, Pedro

AU - Rello, Jordi

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Purpose of reviewOverview of influenza infection, focusing on outcome and complications in critically ill patients. We also discuss relevant elements in immunopathogenesis and their role as predictors of severity.Recent findingsPandemic influenza A (H1N1) virus circulates seasonally and remains the predominant subtype among intensive care patients. Mortality in acute respiratory failure (ARF) is around 20%, independent of influenza subtypes. During severe infection, the imbalance between pro-inflammatory and anti-inflammatory molecules, such as Th1 and Th17 cytokines, is associated with complicated infections and mortality. Primary viral pneumonia presents in more than 70% of ICU influenza patients and more than 50% develop acute respiratory distress syndrome. Bacterial secondary infection occurs in 20% of severe cases and Streptococcus pneumoniae and Staphylococcus aureus remain the prevalent pathogens. Myocarditis and late-onset cardiovascular complications are associated with mortality. Antiviral therapy within 48 h after onset, avoidance of corticosteroids and rescue therapies for ARF or myocarditis, such as extracorporeal membrane oxygenation, improve survival.SummaryThe present review summarizes current knowledge on pathogenesis and clinical manifestations of severe influenza. Immunological dysfunction during viral infection correlates with severity and mortality among ICU patients. A theranostics strategy should be implemented to improve outcomes.

AB - Purpose of reviewOverview of influenza infection, focusing on outcome and complications in critically ill patients. We also discuss relevant elements in immunopathogenesis and their role as predictors of severity.Recent findingsPandemic influenza A (H1N1) virus circulates seasonally and remains the predominant subtype among intensive care patients. Mortality in acute respiratory failure (ARF) is around 20%, independent of influenza subtypes. During severe infection, the imbalance between pro-inflammatory and anti-inflammatory molecules, such as Th1 and Th17 cytokines, is associated with complicated infections and mortality. Primary viral pneumonia presents in more than 70% of ICU influenza patients and more than 50% develop acute respiratory distress syndrome. Bacterial secondary infection occurs in 20% of severe cases and Streptococcus pneumoniae and Staphylococcus aureus remain the prevalent pathogens. Myocarditis and late-onset cardiovascular complications are associated with mortality. Antiviral therapy within 48 h after onset, avoidance of corticosteroids and rescue therapies for ARF or myocarditis, such as extracorporeal membrane oxygenation, improve survival.SummaryThe present review summarizes current knowledge on pathogenesis and clinical manifestations of severe influenza. Immunological dysfunction during viral infection correlates with severity and mortality among ICU patients. A theranostics strategy should be implemented to improve outcomes.

KW - acute respiratory failure

KW - myocarditis

KW - primary viral pneumonia

KW - secondary pneumonia

KW - severe acute respiratory infection

UR - http://www.scopus.com/inward/record.url?scp=85071609902&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071609902&partnerID=8YFLogxK

U2 - 10.1097/MCC.0000000000000638

DO - 10.1097/MCC.0000000000000638

M3 - Review article

C2 - 31313681

AN - SCOPUS:85071609902

VL - 25

SP - 449

EP - 457

JO - Current Opinion in Critical Care

JF - Current Opinion in Critical Care

SN - 1070-5295

IS - 5

ER -