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Impact of pandemic (H1N1) 2009 influenza on critical care capacity in Victoria.
Med J Aust. 2009 Nov 02; 191(9):502-6.MJ

Abstract

OBJECTIVE

To describe the demand for critical care hospital admissions in Victoria resulting from the rapid rise in the number of pandemic (H1N1) 2009 influenza cases, and to describe the role of modelling tools to assist with the response to the pandemic.

DESIGN AND SETTING

Prospective modelling with the tools FluSurge 2.0 and FluAid 2.0 (developed by the United States Centers for Disease Control and Prevention) over 12 weeks from when the pandemic "Contain" Phase was declared on 22 May 2009, compared with data obtained from daily hospital reports of pandemic (H1N1) 2009 influenza-related admissions and transfers to intensive care units (ICUs).

MAIN OUTCOME MEASURES

The effect on hospitals as projected by the FluAid 2.0 model compared with observed hospital admissions and ICU admissions.

RESULTS

Prospective use of the FluAid 2.0 model provided valuable health intelligence for assessment and projection of hospitalisation and critical care demand through the first 10 weeks of the pandemic in Victoria. The observed rate of hospital admissions for pandemic (H1N1) 2009 was broadly consistent with a 5% gross clinical attack rate, with 0.3% of infected patients being hospitalised. Transfers to ICUs occurred at a rate of 20% of hospital admissions, and were associated with vulnerable patient groups, and severe respiratory failure in 82% of patients admitted to ICUs. Most patients treated in ICUs (85%) survived after an average ICU length of stay of 9 days (SD, 6.5 days). Mechanical ventilation was required by 72% of patients admitted to ICUs, and extracorporeal membrane oxygenation (ECMO) was used for 7%. Pre-existing haematological malignancy accounted for half of all the deaths in patients admitted to ICUs with pandemic (H1N1) 2009 influenza.

CONCLUSIONS

Prospective use of modelling tools informed critical decisions in the planning and management of the pandemic. Early estimation of the clinical attack rate, hospitalisation rates, and demand for ICU beds guided implementation of surge capacity. ECMO emerged as an important treatment modality for pandemic (H1N1) 2009 influenza, and will be an important consideration for future pandemic planning.

Authors+Show Affiliations

State Government of Victoria, Department of Health, Melbourne, VIC, Australia. martin.lum@dhs.vic.gov.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19883346

Citation

Lum, Martin E., et al. "Impact of Pandemic (H1N1) 2009 Influenza On Critical Care Capacity in Victoria." The Medical Journal of Australia, vol. 191, no. 9, 2009, pp. 502-6.
Lum ME, McMillan AJ, Brook CW, et al. Impact of pandemic (H1N1) 2009 influenza on critical care capacity in Victoria. Med J Aust. 2009;191(9):502-6.
Lum, M. E., McMillan, A. J., Brook, C. W., Lester, R., & Piers, L. S. (2009). Impact of pandemic (H1N1) 2009 influenza on critical care capacity in Victoria. The Medical Journal of Australia, 191(9), 502-6.
Lum ME, et al. Impact of Pandemic (H1N1) 2009 Influenza On Critical Care Capacity in Victoria. Med J Aust. 2009 Nov 2;191(9):502-6. PubMed PMID: 19883346.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of pandemic (H1N1) 2009 influenza on critical care capacity in Victoria. AU - Lum,Martin E, AU - McMillan,Alison J, AU - Brook,Chris W, AU - Lester,Rosemary, AU - Piers,Leonard S, PY - 2009/08/06/received PY - 2009/08/27/accepted PY - 2009/11/4/entrez PY - 2009/11/4/pubmed PY - 2009/12/23/medline SP - 502 EP - 6 JF - The Medical journal of Australia JO - Med. J. Aust. VL - 191 IS - 9 N2 - OBJECTIVE: To describe the demand for critical care hospital admissions in Victoria resulting from the rapid rise in the number of pandemic (H1N1) 2009 influenza cases, and to describe the role of modelling tools to assist with the response to the pandemic. DESIGN AND SETTING: Prospective modelling with the tools FluSurge 2.0 and FluAid 2.0 (developed by the United States Centers for Disease Control and Prevention) over 12 weeks from when the pandemic "Contain" Phase was declared on 22 May 2009, compared with data obtained from daily hospital reports of pandemic (H1N1) 2009 influenza-related admissions and transfers to intensive care units (ICUs). MAIN OUTCOME MEASURES: The effect on hospitals as projected by the FluAid 2.0 model compared with observed hospital admissions and ICU admissions. RESULTS: Prospective use of the FluAid 2.0 model provided valuable health intelligence for assessment and projection of hospitalisation and critical care demand through the first 10 weeks of the pandemic in Victoria. The observed rate of hospital admissions for pandemic (H1N1) 2009 was broadly consistent with a 5% gross clinical attack rate, with 0.3% of infected patients being hospitalised. Transfers to ICUs occurred at a rate of 20% of hospital admissions, and were associated with vulnerable patient groups, and severe respiratory failure in 82% of patients admitted to ICUs. Most patients treated in ICUs (85%) survived after an average ICU length of stay of 9 days (SD, 6.5 days). Mechanical ventilation was required by 72% of patients admitted to ICUs, and extracorporeal membrane oxygenation (ECMO) was used for 7%. Pre-existing haematological malignancy accounted for half of all the deaths in patients admitted to ICUs with pandemic (H1N1) 2009 influenza. CONCLUSIONS: Prospective use of modelling tools informed critical decisions in the planning and management of the pandemic. Early estimation of the clinical attack rate, hospitalisation rates, and demand for ICU beds guided implementation of surge capacity. ECMO emerged as an important treatment modality for pandemic (H1N1) 2009 influenza, and will be an important consideration for future pandemic planning. SN - 0025-729X UR - https://www.unboundmedicine.com/medline/citation/19883346/Impact_of_pandemic__H1N1__2009_influenza_on_critical_care_capacity_in_Victoria_ L2 - https://www.mja.com.au/public/issues/191_09_021109/lum10916_fm.html DB - PRIME DP - Unbound Medicine ER -