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Conclusion Influenza 2009 H1N1 infection in three southeast European ICUs affected predominantly healthy young patients and was associated with rapid deterioration after hospital admission and severe respiratory and multiorgan failure. These emerging ICUs provided contemporary ICU services, resulting in case-fatality rate comparable to reports from well-established ICU settings. After the first cases of human influenza A H1N1 infection were observed in Mexico in April 2009 (1), the infection quickly spread to Europe, Asia, and both Americas, which is why the World Health Organization (WHO) declared level 6 pandemic alert on June 11, 2009 (2). Up to February 2010, influenza A H1N1 virus was confirmed in more than 212 countries and caused more than 15 000 deaths (3). Compared with seasonal influenza, pandemic 2009 H1N1 influenza A has affected a great number of young, previously healthy patients and caused significant health and economic burden even in developed countries. So far, several studies have reported their experience with critically ill patients with 2009 H1N1 influenza in North America, South America, Asia, Australia, and Europe (1,4-12). A few studies have so far reported on H1N1 patients' characteristics and outcome in low-income and developing countries with limited ICU resources (1,8-12), and none on that in the west Balkans. The ICUs in these countries are mainly run by physicians who lack formal ICU training. Furthermore, until only recently non-surgical critically ill patients in these ICUs had limited access to mechanical ventilation and other life support interventions. However, over the past five years, three university hospitals in Bosnia and Herzegovina and Serbia have established multidisciplinary medical ICUs and most of critically ill patients with H1N1 influenza A infection in the region were admitted to these units. The aim of this study was to describe characteristics and outcomes of mechanically ventilated adult patients with 2009 H1N1 influenza A infection treated in these ICUs.

A large number of studies show elevated levels of nitric oxide (NO) in infective syndromes, but there is an insufficient number of studies which have investigated serum levels of NO in patients with acute respiratory distress syndrome (ARDS), especially in relation to survival. Hence, we created a study with the aim of determining the NO levels in relation to ARDS survival. Serum levels of NO were measured by Griess reaction in 29 patients [16 men (55%), mean age years 52.72±18]. All data were statistically analyzed using one way ANOVA. Our results show significantly higher serum NO levels in ARDS survivors compared to ARDS non-survivors, (p < 0.05). We conclude that higher serum levels of NO are strongly associated with better clinical outcomes, including increased survival.

Intensive care medicine is a relatively new specialty, which was created in the 1950's, after invent of mechanical ventilation, which allowed caring for critically ill patients who otherwise would have died. First created for treating mechanically ventilated patients, ICUs extended their scope and care to all patients with life threatening conditions. Over the years, intensive care medicine developed further and became a truly multidisciplinary speciality, encompassing patients from various fields of medicine and involving specialists from a range of base specialties, with additional (subspecialty) training in intensive care medicine. In Bosnia and Herzegovina, the founding of the society of intensive care medicine in 2006, the introduction of non invasive ventilation in 2007, and opening of a multidisciplinary ICUs in Banja Luka and Sarajevo heralded a new age of intensive care medicine. The number of admissions, high severity scores and needs for mechanical ventilation during the first several months in the medical ICU in Banja Luka confirmed the need of these kinds of units in the country. In spite of still suboptimal personnel training, creation of ICUs in Bosnia and Herzegovina may serve as example for other developing countries in the region. However, in order to achieve modern ICU standards and follow European trends toward harmonisation of medicine, Bosnia and Herzegovina needs to take up this challenge by recognizing intensive care medicine as a distinctive specialty, by implementing a specific training program and by setting up multidisciplinary ICUs in acute care hospitals.