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DOI: 10.1055/s-0030-1269300
Multidisciplinary approach to critically ill adults with novel Influenza A(H1N1) 2009: A case series
Objective: Since 2009 the pandemic Influenza A (H1N1) 2009 emerged as a major cause of respiratory failure. We report the multidisciplinary therapeutic approach and outcome of four critically ill adults with acute respiratory distress syndrome attributable to Influenza A (H1N1) 2009 between November 2009 and March 2010. Due to rapidly progressive respiratory failure unresponsive to mechanical ventilation all required extracorporeal lung support (ECLS).
Methods: All patients with a median age of 52.4 years had confirmed influenza A(H1N1) 2009. Before ECMO, they had a median PaO2/FiO2 ratio of 59mmHg, a median positive end-expiratory pressure of 12.2cm H2O, and a median Murray score of 3.625. The median duration of ECLS was 17 (5–54) days. ECLS was initiated through surgical cannulation with high flow rates around 5–7l/min (veno-venous ECLS n=3, veno-arterial ECLS n=1) In addition to conservative fluid management and nitric oxide inhalation the patients received antiviral therapy with oseltamivir and zanamavir until negative broncho-alveolar lavage results.
Results: Despite complicating factors like obesity, septic cardiac output and pulmonary fibrosis all patients could be weaned (100%). One expired due to cardiac complications, at the time of reporting one survived to discharge (25%), whereas two are inhospital patients. One patient still requires ventilatory support due to pulmonary fibrosis.
Discussion: Extracorporeal lung support provided by a multidisciplinary team may be an effective treatment for patients with H1N1 infection. Surgical cannulation offers the possibility for high flow rates especially required in patients with increased cardiac output due to sepsis.