April - June 2012: 
Volume 25, Issue 2

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Pneumon 2012, 25(2):228-236
Individualized ventilation in influenza A (H1N1) infection: The experience of a single intensive care unit

SUMMARY. Introduction: Severe influenza A infection (H1N1) is associated with acute respiratory failure the management of which challenges intensive care unit (ICU) physicians. The clinical features and outcome of all patients with laboratory-confirmed H1N1 admitted to the Heraklion University Hospital adult ICU during the last two years are reported. Methods: A retrospective observational single centre study was conducted at a tertiary ICU. The medical records of all patients admitted to the ICU with H1N1 infection 10th July 2009 - 1st May 2011 were reviewed. The data collected included demographic characteristics of the patients, the clinical manifestations and illness severity assessed by the Acute Physiology and Chronic Health Evaluation (APACHE) II, and interventions and complications during the ICU stay. The duration of mechanical ventilation, the length of ICU stay and the 60 day mortality were used as outcome indices. Results: During the study period 23 patients with H1N1 were admitted to the ICU. They were relatively young (median age 39 yrs) with a median APACHE II on admission of 12 (range 5-22). In 7 patients (30.4%) there were no comorbidities on admission. In all cases the reason for admission was acute respiratory failure, with a median PaO2/FiO2 128 mmHg (range 83-376). Acute lung injury/ acute respiratory distress syndrome (ALI/ARDS) was the cause of respiratory failure in 21 patients (91.3%), while 2 presented with acute exacerbation of chronic obstructive pulmonary disease (COPD). Twenty patients (87%) required mechanical ventilation; 10 invasive, 5 non invasive and 5 both. Non conventional ventilator management, including oesophageal balloon insertion, high frequency oscillatory ventilation (HFOV), extracorporeal CO2 removal (ECCO2-R) and prone positioning were applied in 8 patients (34.8%). The median duration of mechanical ventilation and median length of ICU stay were 11.6 and 18.6 days, respectively. One patient died (4.3 % mortality). Conclusion: The necessity for non conventional ventilator strategies and the prolonged need for life support characterize the severity of ARDS associated with H1N1 infection. An individualized ventilator approach, based on the principles of lung protective ventilation may have a significant influence on the course of the disease. Pneumon 2012, 25(2):229-236.