Without High-Tech Care, H1N1 Death Toll Could Soar, Studies Suggest

Developing countries with limited access to advanced ICU beds may be in for a rough ride with swine flu and even countries with high-tech ventilation tools may find themselves pushed to the limit as their hospitals struggle to save severely ill H1N1 patients, new studies suggest.

The studies, which compare outcomes among H1N1 patients admitted to intensive care units in Canada and Mexico, showed the death rate in the latter was more than double of that seen in Canadian hospitals. Even in Canadian hospitals, 17 per cent of ICU patients did not survive their illness.

“I think this H1N1, it’s not going to be the one that people would say ‘Oh, my God, that killed off X per cent of our population,” said Dr. Rob Fowler, senior author of both studies.

“But we’re going to see large numbers of patients that have illness, a subset that are critically ill and in different parts of the world it’s actually going to translate into lots of people dying that wouldn’t have otherwise died – especially so if you can’t support them” with ventilators.

The studies were published online Monday by the Journal of the American Medical Association; their publication was timed to coincide with Fowler’s presentation of the data at a conference staged by the European Society of Critical Care Medicine.

This pandemic is not triggering the volume of severe disease experts feared the world might see with the first pandemic of the century. While it’s not currently possible to estimate what percentage of people who catch the virus needs to be hospitalized, it is clear that for most people, H1N1 is indistinguishable from regular influenza.

But a small proportion of patients – most under age 60 – become profoundly ill and do so quickly. Fowler said those who go into this sharp decline generally end up in ICU within about 24 hours of entering hospital.

There medical teams battle to save their lives, hooking these patients up to ventilators that breath for them or even the types of bypass machines – called extracorporeal membrane oxygenation or ECMO – used in cardiac surgery.

Where these resource-intensive therapies are available, chances are decent that H1N1 patients will pull through. Where they are not, the death toll will be higher, Fowler said, a critical-care specialist at Toronto’s Sunnybrook Health Sciences Centre.

The paper looking at outcomes among Mexican patients showed 41 per cent did not survive their infections.

“This is a young, relatively healthy group of patients that has their lungs fail. And if you can throw the book at them to get their lungs through this, then you have a pretty good shot at keeping them alive,” Fowler said.

“And I think in places that aren’t able to do that, well … you have a much lesser likelihood of making it.”

The comparison of the outcomes between the two patient groups – 168 confirmed or probable cases in Canada, 58 in Mexico – provided some other important information.

Fewer of the patients from Mexico were treated with antiviral drugs like Tamiflu, allowing the authors to compare the outcomes of the patients who received the drugs and those who did not.

Treatment with the drugs is recommended for all patients sick enough to require hospitalization, even if treatment starts later than the 48-hour window in which therapy is supposed to start for best results. In Canada, most of the patients would have received the drugs, so there would be no way to really assess whether they were helping or not.

But by comparing the data from the two countries, the authors showed that people who received the drugs were seven times more likely to survive than those who did not.

“People should get these drugs,” Fowler said.

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 Flu Warning Signs

 

The following signs may be seen in a swine flu patient taking a turn for the worst. The U.S. Centers for Disease Control says patients showing these symptoms should seek medical care immediately.

Children: Fast or troubled breathing; skin turning bluish; not drinking enough fluids; being unusually hard to wake up or not interacting; being so irritable that the child doesn’t want to be held, flu-like symptoms improve but then return with fever and worse cough; fever with a rash.

Adults: Difficulty breathing or shortness of breath; pain or pressure in the chest or abdomen; severe or persistent vomiting; sudden dizziness; confusion.

Source: The U.S. Centers for Disease Control.