Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection
Identifieur interne : 000688 ( Istex/Corpus ); précédent : 000687; suivant : 000689Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection
Auteurs : I. Martin-Loeches ; T. Lisboa ; A. Rhodes ; R. P. Moreno ; E. Silva ; C. Sprung ; J. D. Chiche ; D. Barahona ; M. Villabon ; C. Balasini ; R. M. Pearse ; R. Matos ; J. RelloSource :
- Intensive Care Medicine [ 0342-4642 ] ; 2011-02-01.
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Abstract
Abstract: Introduction: Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection, although relatively common, remains controversial. Methods: Prospective, observational, multicenter study from 23 June 2009 through 11 February 2010, reported in the European Society of Intensive Care Medicine (ESICM) H1N1 registry. Results: Two hundred twenty patients admitted to an intensive care unit (ICU) with completed outcome data were analyzed. Invasive mechanical ventilation was used in 155 (70.5%). Sixty-seven (30.5%) of the patients died in ICU and 75 (34.1%) whilst in hospital. One hundred twenty-six (57.3%) patients received corticosteroid therapy on admission to ICU. Patients who received corticosteroids were significantly older and were more likely to have coexisting asthma, chronic obstructive pulmonary disease (COPD), and chronic steroid use. These patients receiving corticosteroids had increased likelihood of developing hospital-acquired pneumonia (HAP) [26.2% versus 13.8%, p < 0.05; odds ratio (OR) 2.2, confidence interval (CI) 1.1–4.5]. Patients who received corticosteroids had significantly higher ICU mortality than patients who did not (46.0% versus 18.1%, p < 0.01; OR 3.8, CI 2.1–7.2). Cox regression analysis adjusted for severity and potential confounding factors identified that early use of corticosteroids was not significantly associated with mortality [hazard ratio (HR) 1.3, 95% CI 0.7–2.4, p = 0.4] but was still associated with an increased rate of HAP (OR 2.2, 95% CI 1.0–4.8, p < 0.05). When only patients developing acute respiratory distress syndrome (ARDS) were analyzed, similar results were observed. Conclusions: Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection did not result in better outcomes and was associated with increased risk of superinfections.
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DOI: 10.1007/s00134-010-2078-z
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Lisboa</name><affiliation><mods:affiliation>Critical Care Department, Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes), Tarragona, Spain</mods:affiliation></affiliation><affiliation><mods:affiliation>Critical Care Department, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil</mods:affiliation></affiliation></author><author><name sortKey="Rhodes, A" sort="Rhodes, A" uniqKey="Rhodes A" first="A." last="Rhodes">A. Rhodes</name><affiliation><mods:affiliation>Critical Care Department, St. George’s Healthcare NHS Trust, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Moreno, R P" sort="Moreno, R P" uniqKey="Moreno R" first="R. P." last="Moreno">R. P. 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Balasini</name><affiliation><mods:affiliation>Unidad de Cuidados Intensivos, Hospital San Martín, La Plata, Buenos Aires, Argentina</mods:affiliation></affiliation></author><author><name sortKey="Pearse, R M" sort="Pearse, R M" uniqKey="Pearse R" first="R. M." last="Pearse">R. M. Pearse</name><affiliation><mods:affiliation>Barts and The London School of Medicine and Dentistry, Queen Mary’s University of London Royal London Hospital, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Matos, R" sort="Matos, R" uniqKey="Matos R" first="R." last="Matos">R. Matos</name><affiliation><mods:affiliation>Unidade de Cuidados Intensivos Polivalente, Hospital de St. António dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E., Lisbon, Portugal</mods:affiliation></affiliation></author><author><name sortKey="Rello, J" sort="Rello, J" uniqKey="Rello J" first="J." last="Rello">J. Rello</name><affiliation><mods:affiliation>Critical Care Department, Vall d’Hebron University Hospital, Institut de Recerca Vall D’Hebron, University Autonoma Barcelona, CIBER Enfermedades Respiratorias (CIBERes), Passeig de la Vall d’Hebron 119-129, 08035, Barcelona, Spain</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: Jrello.hj23.ics@gencat.cat</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:6CDA26C171E33682177E5F4900EFBBF488D817DB</idno><date when="2010" year="2010">2010</date><idno type="doi">10.1007/s00134-010-2078-z</idno><idno type="url">https://api.istex.fr/ark:/67375/VQC-DB7WT78X-B/fulltext.pdf</idno><idno type="wicri:Area/Istex/Corpus">000688</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000688</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection</title><author><name sortKey="Martin Loeches, I" sort="Martin Loeches, I" uniqKey="Martin Loeches I" first="I." last="Martin-Loeches">I. Martin-Loeches</name><affiliation><mods:affiliation>Critical Care Department, Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes), Tarragona, Spain</mods:affiliation></affiliation></author><author><name sortKey="Lisboa, T" sort="Lisboa, T" uniqKey="Lisboa T" first="T." last="Lisboa">T. Lisboa</name><affiliation><mods:affiliation>Critical Care Department, Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes), Tarragona, Spain</mods:affiliation></affiliation><affiliation><mods:affiliation>Critical Care Department, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil</mods:affiliation></affiliation></author><author><name sortKey="Rhodes, A" sort="Rhodes, A" uniqKey="Rhodes A" first="A." last="Rhodes">A. Rhodes</name><affiliation><mods:affiliation>Critical Care Department, St. George’s Healthcare NHS Trust, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Moreno, R P" sort="Moreno, R P" uniqKey="Moreno R" first="R. P." last="Moreno">R. P. Moreno</name><affiliation><mods:affiliation>Unidade de Cuidados Intensivos Polivalente, Hospital de St. António dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E., Lisbon, Portugal</mods:affiliation></affiliation></author><author><name sortKey="Silva, E" sort="Silva, E" uniqKey="Silva E" first="E." last="Silva">E. Silva</name><affiliation><mods:affiliation>ICU, Hospital Israelita Albert Einstein, São Paulo, Brazil</mods:affiliation></affiliation></author><author><name sortKey="Sprung, C" sort="Sprung, C" uniqKey="Sprung C" first="C." last="Sprung">C. Sprung</name><affiliation><mods:affiliation>Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel</mods:affiliation></affiliation></author><author><name sortKey="Chiche, J D" sort="Chiche, J D" uniqKey="Chiche J" first="J. D." last="Chiche">J. D. Chiche</name><affiliation><mods:affiliation>Service de Réanimation Médicale, Hôpital Cochin (AP-HP), Université Paris Descartes, Unité Inserm U567, 75014, Pris, France</mods:affiliation></affiliation></author><author><name sortKey="Barahona, D" sort="Barahona, D" uniqKey="Barahona D" first="D." last="Barahona">D. Barahona</name><affiliation><mods:affiliation>Unidad de Cuidados Intensivos, Hospital Eugenio Espejo, Quito, Ecuador</mods:affiliation></affiliation></author><author><name sortKey="Villabon, M" sort="Villabon, M" uniqKey="Villabon M" first="M." last="Villabon">M. Villabon</name><affiliation><mods:affiliation>Unidad de Cuidados Intensivos, Hospital de San José, Bogotá, Colombia</mods:affiliation></affiliation></author><author><name sortKey="Balasini, C" sort="Balasini, C" uniqKey="Balasini C" first="C." last="Balasini">C. Balasini</name><affiliation><mods:affiliation>Unidad de Cuidados Intensivos, Hospital San Martín, La Plata, Buenos Aires, Argentina</mods:affiliation></affiliation></author><author><name sortKey="Pearse, R M" sort="Pearse, R M" uniqKey="Pearse R" first="R. M." last="Pearse">R. M. Pearse</name><affiliation><mods:affiliation>Barts and The London School of Medicine and Dentistry, Queen Mary’s University of London Royal London Hospital, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Matos, R" sort="Matos, R" uniqKey="Matos R" first="R." last="Matos">R. Matos</name><affiliation><mods:affiliation>Unidade de Cuidados Intensivos Polivalente, Hospital de St. António dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E., Lisbon, Portugal</mods:affiliation></affiliation></author><author><name sortKey="Rello, J" sort="Rello, J" uniqKey="Rello J" first="J." last="Rello">J. Rello</name><affiliation><mods:affiliation>Critical Care Department, Vall d’Hebron University Hospital, Institut de Recerca Vall D’Hebron, University Autonoma Barcelona, CIBER Enfermedades Respiratorias (CIBERes), Passeig de la Vall d’Hebron 119-129, 08035, Barcelona, Spain</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: Jrello.hj23.ics@gencat.cat</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Intensive Care Medicine</title><title level="j" type="abbrev">Intensive Care Med</title><idno type="ISSN">0342-4642</idno><idno type="eISSN">1432-1238</idno><imprint><publisher>Springer-Verlag</publisher><pubPlace>Berlin/Heidelberg</pubPlace><date type="published" when="2011-02-01">2011-02-01</date><biblScope unit="volume">37</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="272">272</biblScope><biblScope unit="page" to="283">283</biblScope></imprint><idno type="ISSN">0342-4642</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0342-4642</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>ARDS</term><term>Community acquired pneumonia</term><term>Corticosteroid therapy</term><term>Pandemic (H1N1)v influenza A infection</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Abstract: Introduction: Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection, although relatively common, remains controversial. Methods: Prospective, observational, multicenter study from 23 June 2009 through 11 February 2010, reported in the European Society of Intensive Care Medicine (ESICM) H1N1 registry. Results: Two hundred twenty patients admitted to an intensive care unit (ICU) with completed outcome data were analyzed. Invasive mechanical ventilation was used in 155 (70.5%). Sixty-seven (30.5%) of the patients died in ICU and 75 (34.1%) whilst in hospital. One hundred twenty-six (57.3%) patients received corticosteroid therapy on admission to ICU. Patients who received corticosteroids were significantly older and were more likely to have coexisting asthma, chronic obstructive pulmonary disease (COPD), and chronic steroid use. These patients receiving corticosteroids had increased likelihood of developing hospital-acquired pneumonia (HAP) [26.2% versus 13.8%, p < 0.05; odds ratio (OR) 2.2, confidence interval (CI) 1.1–4.5]. Patients who received corticosteroids had significantly higher ICU mortality than patients who did not (46.0% versus 18.1%, p < 0.01; OR 3.8, CI 2.1–7.2). Cox regression analysis adjusted for severity and potential confounding factors identified that early use of corticosteroids was not significantly associated with mortality [hazard ratio (HR) 1.3, 95% CI 0.7–2.4, p = 0.4] but was still associated with an increased rate of HAP (OR 2.2, 95% CI 1.0–4.8, p < 0.05). When only patients developing acute respiratory distress syndrome (ARDS) were analyzed, similar results were observed. Conclusions: Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection did not result in better outcomes and was associated with increased risk of superinfections.</div></front></TEI><istex><corpusName>springer-journals</corpusName><author><json:item><name>I. Martin-Loeches</name><affiliations><json:string>Critical Care Department, Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes), Tarragona, Spain</json:string></affiliations></json:item><json:item><name>T. Lisboa</name><affiliations><json:string>Critical Care Department, Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes), Tarragona, Spain</json:string><json:string>Critical Care Department, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil</json:string></affiliations></json:item><json:item><name>A. Rhodes</name><affiliations><json:string>Critical Care Department, St. George’s Healthcare NHS Trust, London, UK</json:string></affiliations></json:item><json:item><name>R. P. Moreno</name><affiliations><json:string>Unidade de Cuidados Intensivos Polivalente, Hospital de St. António dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E., Lisbon, Portugal</json:string></affiliations></json:item><json:item><name>E. Silva</name><affiliations><json:string>ICU, Hospital Israelita Albert Einstein, São Paulo, Brazil</json:string></affiliations></json:item><json:item><name>C. Sprung</name><affiliations><json:string>Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel</json:string></affiliations></json:item><json:item><name>J. D. Chiche</name><affiliations><json:string>Service de Réanimation Médicale, Hôpital Cochin (AP-HP), Université Paris Descartes, Unité Inserm U567, 75014, Pris, France</json:string></affiliations></json:item><json:item><name>D. Barahona</name><affiliations><json:string>Unidad de Cuidados Intensivos, Hospital Eugenio Espejo, Quito, Ecuador</json:string></affiliations></json:item><json:item><name>M. Villabon</name><affiliations><json:string>Unidad de Cuidados Intensivos, Hospital de San José, Bogotá, Colombia</json:string></affiliations></json:item><json:item><name>C. Balasini</name><affiliations><json:string>Unidad de Cuidados Intensivos, Hospital San Martín, La Plata, Buenos Aires, Argentina</json:string></affiliations></json:item><json:item><name>R. M. Pearse</name><affiliations><json:string>Barts and The London School of Medicine and Dentistry, Queen Mary’s University of London Royal London Hospital, London, UK</json:string></affiliations></json:item><json:item><name>R. Matos</name><affiliations><json:string>Unidade de Cuidados Intensivos Polivalente, Hospital de St. António dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E., Lisbon, Portugal</json:string></affiliations></json:item><json:item><name>J. Rello</name><affiliations><json:string>Critical Care Department, Vall d’Hebron University Hospital, Institut de Recerca Vall D’Hebron, University Autonoma Barcelona, CIBER Enfermedades Respiratorias (CIBERes), Passeig de la Vall d’Hebron 119-129, 08035, Barcelona, Spain</json:string><json:string>E-mail: Jrello.hj23.ics@gencat.cat</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Community acquired pneumonia</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Pandemic (H1N1)v influenza A infection</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Corticosteroid therapy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>ARDS</value></json:item></subject><articleId><json:string>2078</json:string><json:string>s00134-010-2078-z</json:string></articleId><arkIstex>ark:/67375/VQC-DB7WT78X-B</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>OriginalPaper</json:string></originalGenre><abstract>Abstract: Introduction: Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection, although relatively common, remains controversial. Methods: Prospective, observational, multicenter study from 23 June 2009 through 11 February 2010, reported in the European Society of Intensive Care Medicine (ESICM) H1N1 registry. Results: Two hundred twenty patients admitted to an intensive care unit (ICU) with completed outcome data were analyzed. Invasive mechanical ventilation was used in 155 (70.5%). Sixty-seven (30.5%) of the patients died in ICU and 75 (34.1%) whilst in hospital. One hundred twenty-six (57.3%) patients received corticosteroid therapy on admission to ICU. Patients who received corticosteroids were significantly older and were more likely to have coexisting asthma, chronic obstructive pulmonary disease (COPD), and chronic steroid use. These patients receiving corticosteroids had increased likelihood of developing hospital-acquired pneumonia (HAP) [26.2% versus 13.8%, p > 0.05; odds ratio (OR) 2.2, confidence interval (CI) 1.1–4.5]. Patients who received corticosteroids had significantly higher ICU mortality than patients who did not (46.0% versus 18.1%, p > 0.01; OR 3.8, CI 2.1–7.2). Cox regression analysis adjusted for severity and potential confounding factors identified that early use of corticosteroids was not significantly associated with mortality [hazard ratio (HR) 1.3, 95% CI 0.7–2.4, p = 0.4] but was still associated with an increased rate of HAP (OR 2.2, 95% CI 1.0–4.8, p > 0.05). When only patients developing acute respiratory distress syndrome (ARDS) were analyzed, similar results were observed. Conclusions: Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection did not result in better outcomes and was associated with increased risk of superinfections.</abstract><qualityIndicators><refBibsNative>false</refBibsNative><abstractWordCount>254</abstractWordCount><abstractCharCount>1871</abstractCharCount><keywordCount>4</keywordCount><score>10</score><pdfWordCount>6199</pdfWordCount><pdfCharCount>44044</pdfCharCount><pdfVersion>1.3</pdfVersion><pdfPageCount>12</pdfPageCount><pdfPageSize>595.276 x 790.866 pts</pdfPageSize></qualityIndicators><title>Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection</title><corporate><json:item><name>The ESICM H1N1 Registry Contributors</name></json:item></corporate><genre><json:string>research-article</json:string></genre><host><title>Intensive Care 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Contributors</orgName></author><author xml:id="author-0000"><persName><forename type="first">I.</forename><surname>Martin-Loeches</surname></persName><affiliation>Critical Care Department, Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes), Tarragona, Spain</affiliation></author><author xml:id="author-0001"><persName><forename type="first">T.</forename><surname>Lisboa</surname></persName><affiliation>Critical Care Department, Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes), Tarragona, Spain</affiliation><affiliation>Critical Care Department, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil</affiliation></author><author xml:id="author-0002"><persName><forename type="first">A.</forename><surname>Rhodes</surname></persName><affiliation>Critical Care Department, St. George’s Healthcare NHS Trust, London, UK</affiliation></author><author xml:id="author-0003"><persName><forename type="first">R.</forename><surname>Moreno</surname></persName><affiliation>Unidade de Cuidados Intensivos Polivalente, Hospital de St. António dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E., Lisbon, Portugal</affiliation></author><author xml:id="author-0004"><persName><forename type="first">E.</forename><surname>Silva</surname></persName><affiliation>ICU, Hospital Israelita Albert Einstein, São Paulo, Brazil</affiliation></author><author xml:id="author-0005"><persName><forename type="first">C.</forename><surname>Sprung</surname></persName><affiliation>Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel</affiliation></author><author xml:id="author-0006"><persName><forename type="first">J.</forename><surname>Chiche</surname></persName><affiliation>Service de Réanimation Médicale, Hôpital Cochin (AP-HP), Université Paris Descartes, Unité Inserm U567, 75014, Pris, France</affiliation></author><author xml:id="author-0007"><persName><forename type="first">D.</forename><surname>Barahona</surname></persName><affiliation>Unidad de Cuidados Intensivos, Hospital Eugenio Espejo, Quito, Ecuador</affiliation></author><author xml:id="author-0008"><persName><forename type="first">M.</forename><surname>Villabon</surname></persName><affiliation>Unidad de Cuidados Intensivos, Hospital de San José, Bogotá, Colombia</affiliation></author><author xml:id="author-0009"><persName><forename type="first">C.</forename><surname>Balasini</surname></persName><affiliation>Unidad de Cuidados Intensivos, Hospital San Martín, La Plata, Buenos Aires, Argentina</affiliation></author><author xml:id="author-0010"><persName><forename type="first">R.</forename><surname>Pearse</surname></persName><affiliation>Barts and The London School of Medicine and Dentistry, Queen Mary’s University of London Royal London Hospital, London, UK</affiliation></author><author xml:id="author-0011"><persName><forename type="first">R.</forename><surname>Matos</surname></persName><affiliation>Unidade de Cuidados Intensivos Polivalente, Hospital de St. António dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E., Lisbon, Portugal</affiliation></author><author xml:id="author-0012" corresp="yes"><persName><forename type="first">J.</forename><surname>Rello</surname></persName><email>Jrello.hj23.ics@gencat.cat</email><affiliation>Critical Care Department, Vall d’Hebron University Hospital, Institut de Recerca Vall D’Hebron, University Autonoma Barcelona, CIBER Enfermedades Respiratorias (CIBERes), Passeig de la Vall d’Hebron 119-129, 08035, Barcelona, Spain</affiliation></author><idno type="istex">6CDA26C171E33682177E5F4900EFBBF488D817DB</idno><idno type="ark">ark:/67375/VQC-DB7WT78X-B</idno><idno type="DOI">10.1007/s00134-010-2078-z</idno><idno type="article-id">2078</idno><idno type="article-id">s00134-010-2078-z</idno></analytic><monogr><title level="j">Intensive Care Medicine</title><title level="j" type="abbrev">Intensive Care Med</title><idno type="pISSN">0342-4642</idno><idno type="eISSN">1432-1238</idno><idno type="journal-ID">true</idno><idno type="issue-article-count">32</idno><idno type="volume-issue-count">12</idno><imprint><publisher>Springer-Verlag</publisher><pubPlace>Berlin/Heidelberg</pubPlace><date type="published" when="2011-02-01"></date><biblScope unit="volume">37</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="272">272</biblScope><biblScope unit="page" to="283">283</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2010-03-25</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Abstract: Introduction: Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection, although relatively common, remains controversial. Methods: Prospective, observational, multicenter study from 23 June 2009 through 11 February 2010, reported in the European Society of Intensive Care Medicine (ESICM) H1N1 registry. Results: Two hundred twenty patients admitted to an intensive care unit (ICU) with completed outcome data were analyzed. Invasive mechanical ventilation was used in 155 (70.5%). Sixty-seven (30.5%) of the patients died in ICU and 75 (34.1%) whilst in hospital. One hundred twenty-six (57.3%) patients received corticosteroid therapy on admission to ICU. Patients who received corticosteroids were significantly older and were more likely to have coexisting asthma, chronic obstructive pulmonary disease (COPD), and chronic steroid use. These patients receiving corticosteroids had increased likelihood of developing hospital-acquired pneumonia (HAP) [26.2% versus 13.8%, p < 0.05; odds ratio (OR) 2.2, confidence interval (CI) 1.1–4.5]. Patients who received corticosteroids had significantly higher ICU mortality than patients who did not (46.0% versus 18.1%, p < 0.01; OR 3.8, CI 2.1–7.2). Cox regression analysis adjusted for severity and potential confounding factors identified that early use of corticosteroids was not significantly associated with mortality [hazard ratio (HR) 1.3, 95% CI 0.7–2.4, p = 0.4] but was still associated with an increased rate of HAP (OR 2.2, 95% CI 1.0–4.8, p < 0.05). When only patients developing acute respiratory distress syndrome (ARDS) were analyzed, similar results were observed. Conclusions: Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection did not result in better outcomes and was associated with increased risk of superinfections.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>Community acquired pneumonia</term></item><item><term>Pandemic (H1N1)v influenza A infection</term></item><item><term>Corticosteroid therapy</term></item><item><term>ARDS</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>Medicine & Public Health</head><item><term>Pediatrics</term></item><item><term>Pain Medicine</term></item><item><term>Pneumology/Respiratory System</term></item><item><term>Emergency Medicine</term></item><item><term>Anesthesiology</term></item><item><term>Intensive / Critical Care Medicine</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2010-03-25">Created</change><change when="2011-02-01">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/ark:/67375/VQC-DB7WT78X-B/fulltext.txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus springer-journals not found" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//Springer-Verlag//DTD A++ V2.4//EN" URI="http://devel.springer.de/A++/V2.4/DTD/A++V2.4.dtd" name="istex:docType"></istex:docType><istex:document><Publisher><PublisherInfo><PublisherName>Springer-Verlag</PublisherName><PublisherLocation>Berlin/Heidelberg</PublisherLocation></PublisherInfo><Journal OutputMedium="All"><JournalInfo JournalProductType="NonStandardArchiveJournal" NumberingStyle="Unnumbered"><JournalID>134</JournalID><JournalPrintISSN>0342-4642</JournalPrintISSN><JournalElectronicISSN>1432-1238</JournalElectronicISSN><JournalTitle>Intensive Care Medicine</JournalTitle><JournalAbbreviatedTitle>Intensive Care Med</JournalAbbreviatedTitle><JournalSubjectGroup><JournalSubject Type="Primary">Medicine & Public Health</JournalSubject><JournalSubject Type="Secondary">Pediatrics</JournalSubject><JournalSubject Type="Secondary">Pain Medicine</JournalSubject><JournalSubject Type="Secondary">Pneumology/Respiratory System</JournalSubject><JournalSubject Type="Secondary">Emergency Medicine</JournalSubject><JournalSubject Type="Secondary">Anesthesiology</JournalSubject><JournalSubject Type="Secondary">Intensive / Critical Care Medicine</JournalSubject></JournalSubjectGroup></JournalInfo><Volume OutputMedium="All"><VolumeInfo TocLevels="0" VolumeType="Regular"><VolumeIDStart>37</VolumeIDStart><VolumeIDEnd>37</VolumeIDEnd><VolumeIssueCount>12</VolumeIssueCount></VolumeInfo><Issue IssueType="Regular" OutputMedium="All"><IssueInfo IssueType="Regular" TocLevels="0"><IssueIDStart>2</IssueIDStart><IssueIDEnd>2</IssueIDEnd><IssueArticleCount>32</IssueArticleCount><IssueHistory><OnlineDate><Year>2011</Year><Month>1</Month><Day>27</Day></OnlineDate><PrintDate><Year>2011</Year><Month>1</Month><Day>26</Day></PrintDate><CoverDate><Year>2011</Year><Month>2</Month></CoverDate><PricelistYear>2011</PricelistYear></IssueHistory><IssueCopyright><CopyrightHolderName>Copyright jointly held by Springer and ESICM</CopyrightHolderName><CopyrightYear>2011</CopyrightYear></IssueCopyright></IssueInfo><Article ID="s00134-010-2078-z" OutputMedium="All"><ArticleInfo ArticleType="OriginalPaper" ContainsESM="No" Language="En" NumberingStyle="Unnumbered" TocLevels="0"><ArticleID>2078</ArticleID><ArticleDOI>10.1007/s00134-010-2078-z</ArticleDOI><ArticleSequenceNumber>13</ArticleSequenceNumber><ArticleTitle Language="En" OutputMedium="All">Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection</ArticleTitle><ArticleCategory>Original</ArticleCategory><ArticleFirstPage>272</ArticleFirstPage><ArticleLastPage>283</ArticleLastPage><ArticleHistory><RegistrationDate><Year>2010</Year><Month>10</Month><Day>29</Day></RegistrationDate><Received><Year>2010</Year><Month>3</Month><Day>25</Day></Received><Accepted><Year>2010</Year><Month>8</Month><Day>24</Day></Accepted><OnlineDate><Year>2010</Year><Month>11</Month><Day>24</Day></OnlineDate></ArticleHistory><ArticleCopyright><CopyrightHolderName>Copyright jointly held by Springer and ESICM</CopyrightHolderName><CopyrightYear>2010</CopyrightYear></ArticleCopyright><ArticleGrants Type="Regular"><MetadataGrant Grant="OpenAccess"></MetadataGrant><AbstractGrant Grant="OpenAccess"></AbstractGrant><BodyPDFGrant Grant="Restricted"></BodyPDFGrant><BodyHTMLGrant Grant="Restricted"></BodyHTMLGrant><BibliographyGrant Grant="Restricted"></BibliographyGrant><ESMGrant Grant="Restricted"></ESMGrant></ArticleGrants></ArticleInfo><ArticleHeader><AuthorGroup><Author AffiliationIDS="Aff1"><AuthorName DisplayOrder="Western"><GivenName>I.</GivenName><FamilyName>Martin-Loeches</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff1 Aff2"><AuthorName DisplayOrder="Western"><GivenName>T.</GivenName><FamilyName>Lisboa</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff3"><AuthorName DisplayOrder="Western"><GivenName>A.</GivenName><FamilyName>Rhodes</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff4"><AuthorName DisplayOrder="Western"><GivenName>R.</GivenName><GivenName>P.</GivenName><FamilyName>Moreno</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff5"><AuthorName DisplayOrder="Western"><GivenName>E.</GivenName><FamilyName>Silva</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff6"><AuthorName DisplayOrder="Western"><GivenName>C.</GivenName><FamilyName>Sprung</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff7"><AuthorName DisplayOrder="Western"><GivenName>J.</GivenName><GivenName>D.</GivenName><FamilyName>Chiche</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff8"><AuthorName DisplayOrder="Western"><GivenName>D.</GivenName><FamilyName>Barahona</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff9"><AuthorName DisplayOrder="Western"><GivenName>M.</GivenName><FamilyName>Villabon</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff10"><AuthorName DisplayOrder="Western"><GivenName>C.</GivenName><FamilyName>Balasini</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff11"><AuthorName DisplayOrder="Western"><GivenName>R.</GivenName><GivenName>M.</GivenName><FamilyName>Pearse</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff4"><AuthorName DisplayOrder="Western"><GivenName>R.</GivenName><FamilyName>Matos</FamilyName></AuthorName></Author><Author AffiliationIDS="Aff12" CorrespondingAffiliationID="Aff12"><AuthorName DisplayOrder="Western"><GivenName>J.</GivenName><FamilyName>Rello</FamilyName></AuthorName><Contact><Email>Jrello.hj23.ics@gencat.cat</Email></Contact></Author><InstitutionalAuthor><InstitutionalAuthorName>The ESICM H1N1 Registry Contributors</InstitutionalAuthorName></InstitutionalAuthor><Affiliation ID="Aff1"><OrgDivision>Critical Care Department</OrgDivision><OrgName>Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes)</OrgName><OrgAddress><City>Tarragona</City><Country Code="ES">Spain</Country></OrgAddress></Affiliation><Affiliation ID="Aff2"><OrgDivision>Critical Care Department</OrgDivision><OrgName>Hospital de Clinicas de Porto Alegre</OrgName><OrgAddress><City>Porto Alegre</City><Country Code="BR">Brazil</Country></OrgAddress></Affiliation><Affiliation ID="Aff3"><OrgName>Critical Care Department, St. George’s Healthcare NHS Trust</OrgName><OrgAddress><City>London</City><Country Code="GB">UK</Country></OrgAddress></Affiliation><Affiliation ID="Aff4"><OrgDivision>Unidade de Cuidados Intensivos Polivalente</OrgDivision><OrgName>Hospital de St. António dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E.</OrgName><OrgAddress><City>Lisbon</City><Country Code="PT">Portugal</Country></OrgAddress></Affiliation><Affiliation ID="Aff5"><OrgName>ICU, Hospital Israelita Albert Einstein</OrgName><OrgAddress><City>São Paulo</City><Country Code="BR">Brazil</Country></OrgAddress></Affiliation><Affiliation ID="Aff6"><OrgDivision>Department of Anesthesiology and Critical Care Medicine</OrgDivision><OrgName>Hadassah Hebrew University Medical Center</OrgName><OrgAddress><City>Jerusalem</City><Country Code="IL">Israel</Country></OrgAddress></Affiliation><Affiliation ID="Aff7"><OrgDivision>Service de Réanimation Médicale, Hôpital Cochin (AP-HP)</OrgDivision><OrgName>Université Paris Descartes</OrgName><OrgAddress><Street>Unité Inserm U567</Street><Postcode>75014</Postcode><City>Pris</City><Country Code="FR">France</Country></OrgAddress></Affiliation><Affiliation ID="Aff8"><OrgDivision>Unidad de Cuidados Intensivos</OrgDivision><OrgName>Hospital Eugenio Espejo</OrgName><OrgAddress><City>Quito</City><Country Code="EC">Ecuador</Country></OrgAddress></Affiliation><Affiliation ID="Aff9"><OrgDivision>Unidad de Cuidados Intensivos</OrgDivision><OrgName>Hospital de San José</OrgName><OrgAddress><City>Bogotá</City><Country Code="CO">Colombia</Country></OrgAddress></Affiliation><Affiliation ID="Aff10"><OrgDivision>Unidad de Cuidados Intensivos</OrgDivision><OrgName>Hospital San Martín</OrgName><OrgAddress><City>La Plata</City><State>Buenos Aires</State><Country Code="AR">Argentina</Country></OrgAddress></Affiliation><Affiliation ID="Aff11"><OrgDivision>Barts and The London School of Medicine and Dentistry</OrgDivision><OrgName>Queen Mary’s University of London Royal London Hospital</OrgName><OrgAddress><City>London</City><Country Code="GB">UK</Country></OrgAddress></Affiliation><Affiliation ID="Aff12"><OrgDivision>Critical Care Department, Vall d’Hebron University Hospital, Institut de Recerca Vall D’Hebron</OrgDivision><OrgName>University Autonoma Barcelona, CIBER Enfermedades Respiratorias (CIBERes)</OrgName><OrgAddress><Street>Passeig de la Vall d’Hebron 119-129</Street><Postcode>08035</Postcode><City>Barcelona</City><Country Code="ES">Spain</Country></OrgAddress></Affiliation></AuthorGroup><Abstract ID="Abs1" Language="En" OutputMedium="All"><Heading>Abstract</Heading><AbstractSection ID="ASec1"><Heading>Introduction</Heading><Para>Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection, although relatively common, remains controversial.</Para></AbstractSection><AbstractSection ID="ASec2"><Heading>Methods</Heading><Para>Prospective, observational, multicenter study from 23 June 2009 through 11 February 2010, reported in the European Society of Intensive Care Medicine (ESICM) H1N1 registry.</Para></AbstractSection><AbstractSection ID="ASec3"><Heading>Results</Heading><Para>Two hundred twenty patients admitted to an intensive care unit (ICU) with completed outcome data were analyzed. Invasive mechanical ventilation was used in 155 (70.5%). Sixty-seven (30.5%) of the patients died in ICU and 75 (34.1%) whilst in hospital. One hundred twenty-six (57.3%) patients received corticosteroid therapy on admission to ICU. Patients who received corticosteroids were significantly older and were more likely to have coexisting asthma, chronic obstructive pulmonary disease (COPD), and chronic steroid use. These patients receiving corticosteroids had increased likelihood of developing hospital-acquired pneumonia (HAP) [26.2% versus 13.8%, <Emphasis Type="Italic">p</Emphasis> < 0.05; odds ratio (OR) 2.2, confidence interval (CI) 1.1–4.5]. Patients who received corticosteroids had significantly higher ICU mortality than patients who did not (46.0% versus 18.1%, <Emphasis Type="Italic">p</Emphasis> < 0.01; OR 3.8, CI 2.1–7.2). Cox regression analysis adjusted for severity and potential confounding factors identified that early use of corticosteroids was not significantly associated with mortality [hazard ratio (HR) 1.3, 95% CI 0.7–2.4, <Emphasis Type="Italic">p</Emphasis> = 0.4] but was still associated with an increased rate of HAP (OR 2.2, 95% CI 1.0–4.8, <Emphasis Type="Italic">p</Emphasis> < 0.05). When only patients developing acute respiratory distress syndrome (ARDS) were analyzed, similar results were observed.</Para></AbstractSection><AbstractSection ID="ASec4"><Heading>Conclusions</Heading><Para>Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection did not result in better outcomes and was associated with increased risk of superinfections.</Para></AbstractSection></Abstract><KeywordGroup Language="En" OutputMedium="All"><Heading>Keywords</Heading><Keyword>Community acquired pneumonia</Keyword><Keyword>Pandemic (H1N1)v influenza A infection</Keyword><Keyword>Corticosteroid therapy</Keyword><Keyword>ARDS</Keyword></KeywordGroup><ArticleNote Type="Misc"><SimplePara>Endorsed by the European Critical Care Research Network (ECCRN) of the European Society of Intensive Care Medicine (ESICM).</SimplePara></ArticleNote><ArticleNote Type="Misc"><SimplePara>ESICM H1N1 Registry Contributors are listed in the Appendix.</SimplePara></ArticleNote><ArticleNote Type="Misc"><SimplePara>Abstract selected as oral presentation in 23rd ESICM Annual Congress 2010.</SimplePara></ArticleNote></ArticleHeader><NoBody></NoBody></Article></Issue></Volume></Journal></Publisher></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection</title></titleInfo><name type="corporate"><namePart>The ESICM H1N1 Registry Contributors</namePart></name><name type="personal"><namePart type="given">I.</namePart><namePart type="family">Martin-Loeches</namePart><affiliation>Critical Care Department, Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes), Tarragona, Spain</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">T.</namePart><namePart type="family">Lisboa</namePart><affiliation>Critical Care Department, Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes), Tarragona, Spain</affiliation><affiliation>Critical Care Department, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A.</namePart><namePart type="family">Rhodes</namePart><affiliation>Critical Care Department, St. George’s Healthcare NHS Trust, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">R.</namePart><namePart type="given">P.</namePart><namePart type="family">Moreno</namePart><affiliation>Unidade de Cuidados Intensivos Polivalente, Hospital de St. António dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E., Lisbon, Portugal</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">E.</namePart><namePart type="family">Silva</namePart><affiliation>ICU, Hospital Israelita Albert Einstein, São Paulo, Brazil</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">C.</namePart><namePart type="family">Sprung</namePart><affiliation>Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.</namePart><namePart type="given">D.</namePart><namePart type="family">Chiche</namePart><affiliation>Service de Réanimation Médicale, Hôpital Cochin (AP-HP), Université Paris Descartes, Unité Inserm U567, 75014, Pris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">D.</namePart><namePart type="family">Barahona</namePart><affiliation>Unidad de Cuidados Intensivos, Hospital Eugenio Espejo, Quito, Ecuador</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M.</namePart><namePart type="family">Villabon</namePart><affiliation>Unidad de Cuidados Intensivos, Hospital de San José, Bogotá, Colombia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">C.</namePart><namePart type="family">Balasini</namePart><affiliation>Unidad de Cuidados Intensivos, Hospital San Martín, La Plata, Buenos Aires, Argentina</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">R.</namePart><namePart type="given">M.</namePart><namePart type="family">Pearse</namePart><affiliation>Barts and The London School of Medicine and Dentistry, Queen Mary’s University of London Royal London Hospital, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">R.</namePart><namePart type="family">Matos</namePart><affiliation>Unidade de Cuidados Intensivos Polivalente, Hospital de St. António dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E., Lisbon, Portugal</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal" displayLabel="corresp"><namePart type="given">J.</namePart><namePart type="family">Rello</namePart><affiliation>Critical Care Department, Vall d’Hebron University Hospital, Institut de Recerca Vall D’Hebron, University Autonoma Barcelona, CIBER Enfermedades Respiratorias (CIBERes), Passeig de la Vall d’Hebron 119-129, 08035, Barcelona, Spain</affiliation><affiliation>E-mail: Jrello.hj23.ics@gencat.cat</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="OriginalPaper" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>Springer-Verlag</publisher><place><placeTerm type="text">Berlin/Heidelberg</placeTerm></place><dateCreated encoding="w3cdtf">2010-03-25</dateCreated><dateIssued encoding="w3cdtf">2011-02-01</dateIssued><copyrightDate encoding="w3cdtf">2010</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><abstract lang="en">Abstract: Introduction: Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection, although relatively common, remains controversial. Methods: Prospective, observational, multicenter study from 23 June 2009 through 11 February 2010, reported in the European Society of Intensive Care Medicine (ESICM) H1N1 registry. Results: Two hundred twenty patients admitted to an intensive care unit (ICU) with completed outcome data were analyzed. Invasive mechanical ventilation was used in 155 (70.5%). Sixty-seven (30.5%) of the patients died in ICU and 75 (34.1%) whilst in hospital. One hundred twenty-six (57.3%) patients received corticosteroid therapy on admission to ICU. Patients who received corticosteroids were significantly older and were more likely to have coexisting asthma, chronic obstructive pulmonary disease (COPD), and chronic steroid use. These patients receiving corticosteroids had increased likelihood of developing hospital-acquired pneumonia (HAP) [26.2% versus 13.8%, p < 0.05; odds ratio (OR) 2.2, confidence interval (CI) 1.1–4.5]. Patients who received corticosteroids had significantly higher ICU mortality than patients who did not (46.0% versus 18.1%, p < 0.01; OR 3.8, CI 2.1–7.2). Cox regression analysis adjusted for severity and potential confounding factors identified that early use of corticosteroids was not significantly associated with mortality [hazard ratio (HR) 1.3, 95% CI 0.7–2.4, p = 0.4] but was still associated with an increased rate of HAP (OR 2.2, 95% CI 1.0–4.8, p < 0.05). When only patients developing acute respiratory distress syndrome (ARDS) were analyzed, similar results were observed. Conclusions: Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection did not result in better outcomes and was associated with increased risk of superinfections.</abstract><note>Original</note><subject lang="en"><genre>Keywords</genre><topic>Community acquired pneumonia</topic><topic>Pandemic (H1N1)v influenza A infection</topic><topic>Corticosteroid therapy</topic><topic>ARDS</topic></subject><relatedItem type="host"><titleInfo><title>Intensive Care Medicine</title></titleInfo><titleInfo type="abbreviated"><title>Intensive Care Med</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><originInfo><publisher>Springer</publisher><dateIssued encoding="w3cdtf">2011-01-27</dateIssued><copyrightDate encoding="w3cdtf">2011</copyrightDate></originInfo><subject><genre>Medicine & Public Health</genre><topic>Pediatrics</topic><topic>Pain Medicine</topic><topic>Pneumology/Respiratory System</topic><topic>Emergency Medicine</topic><topic>Anesthesiology</topic><topic>Intensive / Critical Care Medicine</topic></subject><identifier type="ISSN">0342-4642</identifier><identifier type="eISSN">1432-1238</identifier><identifier type="JournalID">134</identifier><identifier type="IssueArticleCount">32</identifier><identifier type="VolumeIssueCount">12</identifier><part><date>2011</date><detail type="volume"><number>37</number><caption>vol.</caption></detail><detail type="issue"><number>2</number><caption>no.</caption></detail><extent unit="pages"><start>272</start><end>283</end></extent></part><recordInfo><recordOrigin>Copyright jointly held by Springer and ESICM, 2011</recordOrigin></recordInfo></relatedItem><identifier type="istex">6CDA26C171E33682177E5F4900EFBBF488D817DB</identifier><identifier type="ark">ark:/67375/VQC-DB7WT78X-B</identifier><identifier type="DOI">10.1007/s00134-010-2078-z</identifier><identifier type="ArticleID">2078</identifier><identifier type="ArticleID">s00134-010-2078-z</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright jointly held by Springer and ESICM, 2010</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-3XSW68JL-F">springer</recordContentSource><recordOrigin>Copyright jointly held by Springer and ESICM, 2010</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/ark:/67375/VQC-DB7WT78X-B/record.json</uri></json:item></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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|texte= Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection
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