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Clinical course of ICU patients with severe pandemic 2009 influenza A (H1N1) pneumonia: single center experience with proning and pressure release ventilation.
- Source :
-
Journal of intensive care medicine [J Intensive Care Med] 2012 May-Jun; Vol. 27 (3), pp. 184-90. Date of Electronic Publication: 2011 May 18. - Publication Year :
- 2012
-
Abstract
- Background: A number of different modalities have been employed in addition to conventional ventilation to improve oxygenation in patients with severe 2009 pandemic influenza A (H1N1) pneumonia. Outcomes with ventilatory and rescue therapies for H1N1 influenza-related acute respiratory distress syndrome (ARDS) have been varied. A single intensive care unit (ICU) experience with management of laboratory-confirmed 2009 pandemic influenza A (H1N1) ARDS with a combination of proning and airway pressure release ventilation (APRV) is described.<br />Methods: A retrospective review of medical records of ICU patients seen at Utah Valley Regional Medical Center during the first and second waves of the H1N1 influenza pandemic was done.<br />Results: Fourteen ICU patients were managed with invasive ventilation for 2009 pandemic influenza A (H1N1)-related ARDS. Hypoxemia refractory to conventional ventilation was noted in 11 of 14 patients despite application of APRV. Following proning in patients on APRV, improvement of hypoxemia and hemodynamic status was achieved. Only 2 of 11 patients on APRV and proning required continuous dialysis. Mortality in intubated patients receiving a combination of proning and APRV was 27.3% (3/11) with 2 of these dying during the first wave of the H1N1 influenza pandemic. In all, 3 of 11 patients on proning and APRV underwent tracheostomy, with 2 of these undergoing tube thoracostomy. ARDSnet fluid-conservative protocol was safely tolerated in 8 of 11 of the intubated patients following initiation of proning and APRV.<br />Conclusions: Proning in combination with APRV provides improvement of hypoxemia with limitation of end-organ dysfunction and thereby facilitates recovery from severe 2009 pandemic influenza A (H1N1).
- Subjects :
- APACHE
Adult
Continuous Positive Airway Pressure methods
Female
Hospitalization statistics & numerical data
Humans
Influenza, Human complications
Influenza, Human therapy
Length of Stay
Male
Medical Records
Middle Aged
Oxygen blood
Respiration, Artificial
Respiratory Distress Syndrome etiology
Respiratory Distress Syndrome therapy
Retrospective Studies
Treatment Outcome
Utah epidemiology
Influenza A Virus, H1N1 Subtype
Influenza, Human epidemiology
Intensive Care Units statistics & numerical data
Intensive Care Units trends
Pandemics
Respiratory Distress Syndrome epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1525-1489
- Volume :
- 27
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of intensive care medicine
- Publication Type :
- Academic Journal
- Accession number :
- 21593048
- Full Text :
- https://doi.org/10.1177/0885066610396168