PMID: 21540806May 5, 2011Paper

Systematic approach for severe respiratory failure due to novel A (H1N1) influenza

Minerva anestesiologica
R CornejoR González

Abstract

In April 2009, a novel influenza A (H1N1) virus appeared in Mexico. It rapidly acquired the characteristics of a pandemic disease. Our objective is to present a case series of mechanically ventilated patients with severe influenza, treated with a systematic approach. Prospective, observational, single-center study in a University Hospital. A (H1N1) virus was confirmed by rRT-PCR. In this report, we only considered patients that required mechanical ventilation (MV). All patients received antibiotics, steroids and oseltamivir from the time of admission. The main strategies incorporated in the systematic approach were a lung-protective strategy, PEEP adjusted for each patient, protocol-guided sedoanalgesia, restrictive fluid management, weaning protocol, and prolonged prone ventilation and extracorporeal membrane oxygenation (ECMO) as rescue therapies. We studied 19 patients: age 41 ± 13 years old, APACHE II 16 ± 7 and SOFA 8 ± 4. All patients presented PaO2/FiO2 ≤ 200 before connection to MV. Their worst values within the first 24 hours for oxygenation index, PaO2/FiO2, and PaCO2 on MV were 21.8 ± 13, 98 ± 39, and 48 ± 16 mmHg, respectively. Sixteen patients achieved ARDS; three exhibited acute lung injury criteria. Ten required ...Continue Reading

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