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Primary viral pneumonia was defined in patients in the acute phase of influenza virus illness who presented with acute respiratory distress and unequivocal alveolar opacities with negative respiratory and blood bacterial cultures. Secondary bacterial pneumonia was considered in patients with confirmation of influenza virus infection who showed recurrence of fever, increase in cough and production of purulent sputum plus positive bacterial respiratory or blood cultures [17]. Respiratory cultures were based on tracheal aspirates obtained immediately after intubation. Acute renal failure was defined as the need for renal replacement therapy, in accordance with the International Consensus Conference criteria [18]. We have defined comorbidities as Cefaloridine the pathological antecedents of each patient, and antiviral gap as time of delay between the onset of symptoms and the start of antiviral Carfilzomib in vitro treatment. Multiple organ dysfunction syndrome (MODS) and shock were defined following international criteria [15,19]. NIV was always used for ARF at an early stage. Failure of NIV was defined if the patient was intubated and invasively ventilated after an NIV trial (when Spo2?VX-809 research buy patients, compared with other subgroups, are briefly described in Table?1. Compared with non-ventilated subjects, patients with successful NIV presented more comorbidities (70.8 versus 57%; p?