UMEM Educational Pearls

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.


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.