Pandemic (H1N1) 2009 influenza: experience from the critical care unit

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Respiratory Medicine

Background:

• The 2009 influenza pandemic (H1N1) presented a significant challenge to healthcare systems globally.
• Intensive care units (ICUs) required specific strategies to manage critically ill patients with severe respiratory compromise.

Observation:

• This case series reports on four critically ill patients admitted to a West Midlands ICU with pandemic H1N1 influenza.
• Patients presented with severe hypoxia, with two failing continuous positive airway pressure (CPAP) trials.
• All patients required mechanical ventilation within 24 hours of admission, with bilevel and high-frequency oscillatory ventilation proving most effective.

Findings:

• The majority of patients experienced single-organ failure and had relatively short durations of ventilator dependence.
• Three out of the four patients achieved a full recovery.
• One patient required ongoing dialysis, indicating potential for prolonged complications.

Implications:

• The findings offer valuable insights for other ICUs in preparing for potential surges of H1N1 cases.
• Effective service planning and adaptable response strategies are crucial for managing influenza pandemics.
• Experience with mechanical ventilation modes like bilevel and HFOV is essential for critical care management of severe influenza.