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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2011 September;77(9):884-91
Management of acute respiratory complications from influenza A (H1N1) infection: experience of a tertiary-level Intensive Care Unit
Grasselli G. 1, Bombino M. 1, Patroniti N. 1,2, Foti G. 1, Benini A. 1, Abbruzzese C. 1, Fumagalli R. 1,2, Pesenti A. 1,2 ✉
1 Department of Perioperative Medicine and Intensive Care, San Gerardo Hospital, Monza, Italy;
2 Department of Experimental Medicine, University of Milano-Bicocca, Milan, Italy
BACKGROUND: The novel influenza A (H1N1) pandemic was associated with an epidemic of critical illness.
METHODS: We describe the clinical profiles of critically ill patients with severe complications due to microbiologically confirmed pandemic influenza A (H1N1) infection admitted to a medical ICU in Monza, Italy, over a 6-month period.
RESULTS: From August 2009 to January 2010, 19 patients (13 adults and 6 children) required ICU admission. Nine subjects were referred to our hospital from other ICUs. In all patients, with the exception of a case of severe septic shock, the cause of ICU admission was acute respiratory failure. Other nonpulmonary organ failures were common. A trial of non-invasive ventilation was attempted in 13 cases and was successful in four of them. The majority of the patients required invasive mechanical ventilation. In the 7 most severely hypoxemic patients, we applied veno-venous ECLS, with a very high rate of success. The median ICU stay was 9 days (range 1-78 days). Sixteen out of 19 (84%) patients survived.
CONCLUSION: In the majority of our patients, critical illness caused by pandemic influenza A (H1N1) was associated with severe hypoxemia, multiple organ failure, requirement for mechanical ventilation and frequent use of rescue therapies and ECLS support.