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Most H1N1 patients with respiratory failure treated with oxygenating system survive illness
October 13, 2009Despite the severity of disease and the intensity of treatment, most patients in Australia and New Zealand who experienced respiratory failure as a result of 2009 influenza A(H1N1) and were treated with a system that adds oxygen to the patient's blood survived the disease, according to a study to appear in the November 4 issue of JAMA. This study is being published early online because of its public health importance.
The influenza A(H1N1) pandemic affected Australia and New Zealand during the 2009 southern hemisphere winter, causing an epidemic of critical illness. Some patients developed severe acute respiratory distress syndrome (ARDS) and were treated with extracorporeal membrane oxygenation (ECMO), according to background information in the article.
ARDS is a lung condition that leads to respiratory failure due to the rapid accumulation of fluid in the lungs. ECMO is a type of life support that circulates blood through a system that adds oxygen. ECMO was used for the patients in this study because they developed very low blood oxygen levels that developed rapidly despite standard ventilator (or respirator) settings. ECMO is generally used for a limited time because of the risks of bleeding, clotting, infection, and organ failure.
The Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators in collaboration with the Australian and New Zealand Intensive Care Research Centre at Monash University in Melbourne, conducted an observational study of patients with 2009 influenza A(H1N1)-associated ARDS treated with ECMO in 15 intensive care units (ICUs) in Australia and New Zealand between June 1 and August 31, 2009. The researchers looked at incidence, clinical features, the degree of lung dysfunction, technical characteristics, the duration of ECMO, complications, and survival.
The study found that 68 patients with severe influenza-associated ARDS were treated with ECMO, including 53 with confirmed 2009 influenza A(H1N1). An additional 133 patients with influenza A received mechanical ventilation, but not ECMO, in the same ICUs. The 68 patients who received ECMO had a median (midpoint) age of 34.4 years and half were men.
"Affected patients were often young adults, pregnant or postpartum, obese, had severe respiratory failure before ECMO, and received prolonged mechanical ventilation and ECMO support," the authors write.
The median duration of ECMO support was ten days. At the time of reporting, 54 of the 68 patients had survived and 14 (21 percent) had died. Six patients remained in ICU, including two who were still receiving ECMO. Sixteen patients were still hospitalized, but out of ICU, and 32 had been discharged from the hospital.
"Despite their illness severity and the prolonged use of life support, most of these patients survived," the authors conclude. "This information should facilitate health care planning and clinical management for these complex patients during the ongoing pandemic."
JAMA and Archives Journals
The Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators in collaboration with the Australian and New Zealand Intensive Care Research Centre at Monash University in Melbourne, conducted an observational study of patients with 2009 influenza A(H1N1)-associated ARDS treated with ECMO in 15 intensive care units (ICUs) in Australia and New Zealand between June 1 and August 31, 2009. The researchers looked at incidence, clinical features, the degree of lung dysfunction, technical characteristics, the duration of ECMO, complications, and survival.
The study found that 68 patients with severe influenza-associated ARDS were treated with ECMO, including 53 with confirmed 2009 influenza A(H1N1). An additional 133 patients with influenza A received mechanical ventilation, but not ECMO, in the same ICUs. The 68 patients who received ECMO had a median (midpoint) age of 34.4 years and half were men.
"Affected patients were often young adults, pregnant or postpartum, obese, had severe respiratory failure before ECMO, and received prolonged mechanical ventilation and ECMO support," the authors write.
The median duration of ECMO support was ten days. At the time of reporting, 54 of the 68 patients had survived and 14 (21 percent) had died. Six patients remained in ICU, including two who were still receiving ECMO. Sixteen patients were still hospitalized, but out of ICU, and 32 had been discharged from the hospital.
"Despite their illness severity and the prolonged use of life support, most of these patients survived," the authors conclude. "This information should facilitate health care planning and clinical management for these complex patients during the ongoing pandemic."
JAMA and Archives Journals
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Multicenter study led by pitt finds early results of therapy for preemies not sustained
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H1N1 critical illness can occur rapidly; predominantly affects young patients
Critical illness among Canadian patients with 2009 influenza A(H1N1) occurred rapidly after hospital admission, often in young adults, and was associated with severely low levels of oxygen in the blood, multi-system organ failure, a need for prolonged mechanical ventilation, and frequent use of rescue therapies.
Intensive care procedure saves lives: Swine flu study
A research team has warned medical experts in the Northern Hemisphere not to underestimate the serious impact of the H1N1 (Swine flu) virus with a new report showing that many patients who were critically ill with the virus required prolonged life support treatment with heart-lung machines.
Should noninvasive ventilation be considered a high-risk procedure during an epidemic?
Contrary to current policies recommending that non-invasive ventilation be avoided during an infectious outbreak, the author of a commentary in CMAJ (Canadian Medical Association Journal) argues that it should be used expeditiously in this setting.
Implementation of acute care surgery service provides more timely patient care
A new study published in the October issue of the Journal of the American College of Surgeons shows that the establishment of an acute care surgery service can help surgeons at academic medical centers provide more timely care to the growing number of patients who are transferred from the emergency room or smaller hospitals and who require an immediate operation.
Mutation responsible for cystic fibrosis also involved in muscle atrophy
Patients with cystic fibrosis (CF) usually experience significant muscle loss, a symptom traditionally considered to be a secondary complication of the devastating genetic disease.
Nitrous gases and zinc in the crosshairs
The Senate Commission for the Investigation of Health Hazards of Chemical Compounds in the Work Area established by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) has issued the MAK and BAT Values List for 2009. This year's list contains 62 changes and new entries.
Low birth weight linked to long-term respiratory problems
Infants who weigh less than five and a half pounds at birth often enter the world with a host of medical complications, including respiratory problems.
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