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Editorials |

Should We “Rescue” Patients With 2009 Influenza A(H1N1) and Lung Injury From Conventional Mechanical Ventilation?

Rolf D. Hubmayr, MD, FCCP; J. Christopher Farmer, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine.

Correspondence to: Rolf D. Hubmayr, MD, FCCP, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: rhubmayr@mayo.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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):745-747. doi:10.1378/chest.09-2915
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In 2009, the world experienced a novel influenza A(H1N1) [A(H1N1)] pandemic, which stressed critical care delivery systems with an onslaught of patients with severe, life-threatening respiratory failure. Case series from different parts of the world now provide a fairly comprehensive account of patient characteristics and outcomes1234-5 and have raised interesting questions about risk factors and disease modifiers of acute lung injury and ARDS. We have learned that patients with A(H1N1) who are admitted to ICUs tend to be comparatively young, frequently obese, and more frequently pregnant. Those who suffer from ARDS can be very difficult to oxygenate by conventional means. Consequently, during a 2-month time span at the peak of the epidemic in Australia and New Zealand, 68 patients with influenza-associated ARDS were transitioned to extracorporeal membrane oxygenation (ECMO) after presumed failure of conventional treatment.6 The severity of ARDS before commencement of ECMO was reflected in median values as follows: lowest ratio of Po2 in blood relative to the fractional concentration of oxygen in inspired gas, 56; highest positive end-expiratory pressure, 18 cm H2O; highest peak airway pressure, 36 cm H2O; highest Pco2, 69 torr; and lowest pH, 7.2. Many of these patients failed other “rescue” attempts, such as prone positioning and high-frequency oscillatory ventilation (HFOV), as well as nitric oxide and prostacyclin supplementation. Remarkably, 71% of patients managed with ECMO were alive at ICU discharge and one-third were ultimately discharged home. Overall, mortality at the time of the report (some patients were still in ICUs, rehabilitation facilities, and other institutions) was 21%.

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