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Recent Advances in Chest Medicine |

Clinical Management of Pandemic 2009 Influenza A(H1N1) Infection

David S. Hui, MD, FCCP; Nelson Lee, MD; Paul K. S. Chan, MD
Author and Funding Information

From the Department of Medicine and Therapeutics (Drs Hui and Lee), the Stanley Ho Center for Emerging Infectious Diseases, School of Public Health & Primary Care (Drs Hui, Lee, and Chan), and the Department of Microbiology (Dr Chan), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.

Correspondence to: David S Hui, MD, FCCP, Division of Respiratory Medicine, The Chinese University of Hong Kong, 9/F, Prince of Wales Hospital, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong; e-mail: dschui@cuhk.edu.hk


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(4):916-925. doi:10.1378/chest.09-2344
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Antiviral therapy and vaccination are important strategies for controlling pandemic 2009 influenza A(H1N1) but efficacy depends on the timing of administration and is often limited by supply shortage. Patients with dyspnea, tachypnea, evidence of hypoxemia, and pulmonary infiltrates on chest radiograph should be hospitalized. Patients with severe illness or underlying medical conditions that increase the risk of more severe disease should be treated with oseltamivir or zanamivir as soon as possible, without waiting for the results of laboratory tests. Lung-protective ventilation strategy with a low tidal volume and adequate pressure, in addition to a conservative fluid management approach, is recommended when treating adult patients with ARDS. Extracorporeal membrane oxygenation has emerged as an important rescue therapy for critically ill patients. Use of systemic steroids was associated with delayed viral clearance in severe acute respiratory syndrome and H3N2 infection. Low-dose corticosteroids may be considered in the treatment of refractory septic shock. Passive immunotherapy in the form of convalescent plasma or hyperimmune globulin may be explored as rescue therapy. More data are needed to explore the potential role of IV gamma globulin and other drugs with immunomodulating properties, such as statins, gemfibrozil, and N-acetyl-cysteine. Health-care workers must apply strict standard and droplet precautions when dealing with suspected and confirmed case and upgrade to airborne precautions when performing aerosol-generating procedures. Nonpharmacologic measures, such as early case isolation, household quarantine, school/workplace closure, good community hygiene, and restrictions on travel are useful measures in controlling an influenza pandemic at its early phase.

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