UMEM Educational Pearls

Title: Critically Ill Patients with H1N1

Posted: 10/13/2009 by Mike Winters, MBA, MD (Updated: 11/22/2024)
Click here to contact Mike Winters, MBA, MD

Critically Ill Patients with H1N1

Three recent reports published online in the Journal of the Americal Medical Association (JAMA) detail the potential problems of H1N1 infection in the critically ill.
The three studies (Mexico, Canada, Australia/New Zealand) seem to have recurring themes:
- shock and multisystem organ failure were common
- many were healthy, young adults who developed rapid respiratory failure
- hypoxemia was prolonged and often refractory to conventional modes of mechanical ventilation
Newer modes of ventilation and therapies were required to treat refractory hypoxemia. These included high frequency oscillatory ventilation, prone positioning, neuromuscular blockade, nitric oxide, and extracorporeal membrane oxygenation.
Take Home Point: Involve your intensivist early in the management of ED patients with respiratory failure and suspected H1N1 infection, as non-conventional methods of ventilation may be needed to treat hypoxemia.

References

Dominguez-Cherit G, Lapinsky SE, Macias AE, et al. Critically ill patients with 2009 influenza A (H1N1) in Mexico. JAMA (published online October 12, 2009) doi:10.1001/jama.2009. 1536.

Kumar A, Zarychanski R, Pinto R, et al. Canadian Critical Care Trials Group H1N1 Collaborative. Critically ill patients with 2009 influenza A (H1N1) infection in Canada. JAMA (published online October 12, 2009) doi:10.1001/jama.2009. 1496.

The Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) influenza Investigators. Extracorporeal membrane oxygenation for 2009 influenza A (H1N1) acute respiratory distress syndrome. JAMA (published online October 12, 2009) doi.10.1001/jama.2009. 1535.