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Russell R. Miller, III, MD; Boaz A. Markewitz, MD, FCCP; Robert T. Rolfs, MD; Samuel M. Brown, MD; Kristin K. Dascomb, MD, PhD; Colin K. Grissom, MD, FCCP; Michael D. Friedrichs, MS; Jeanmarie Mayer, MD; Ellie L. Hirshberg, MD; Jamie Conklin, MD; Robert Paine, III, MD; Nathan C. Dean, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Medicine (Drs Miller, Brown, Grissom, Hirshberg, and Dean) and the Department of Clinical Epidemiology and Infectious Diseases (Dr Dascomb), Intermountain Medical Center, Murray; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine (Drs Miller, Markewitz, Brown, Grissom, Hirshberg, Conklin, Paine, and Dean) and the Divisions of Epidemiology and Infectious Diseases (Dr Mayer), University of Utah Health Sciences Center, Salt Lake City; and the Utah Department of Health (Dr Rolfs and Mr Friedrichs).

Correspondence to: Russell R. Miller III, MD, Intermountain Medical Center, Respiratory Intensive Care Unit, 5121 S Cottonwood St, Murray, UT 84107; e-mail: Russ.Miller@imail.org


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;138(2):455-456. doi:10.1378/chest.10-1186
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To the Editor:

We appreciate the interest of Dr Yan and colleagues in our case series of patients admitted to ICUs in Salt Lake County, Utah, during the first wave of the novel 2009 influenza A(H1N1) pandemic, which appeared in a recent issue of CHEST (April 2010).1 They suggest differences between our cohort and the cohort of patients who were critically ill with influenza and who received extracorporeal membrane oxygenation (ECMO) in Australia and New Zealand.2 The primary focus of our paper was to report our experience and epidemiologic observations. In the absence of a randomized clinical trial, “salvage therapies” such as ECMO should not be advocated. Multiple such interventions in patients who had ARDS have proven ineffective in clinical trials.3-9 In our experience, rigorous, protocol-driven ventilation with low tidal volumes (an approach demonstrated to improve mortality in the Acute Respiratory Management in ARDS trial10) is associated with impressive survival rates, even in patients with profoundly hypoxemic ARDS.

Miller RR III, Markewitz BA, Rolfs RT, et al. Clinical findings and demographic factors associated with ICU admission in Utah due to novel 2009 influenza A(H1N1) infection. Chest. 2010;1374:752-758. [CrossRef] [PubMed]
 
Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza InvestigatorsAustralia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza InvestigatorsDavies A, Jones D, Bailey M, et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA. 2009;30217:1888-1895. [CrossRef] [PubMed]
 
Zapol WM, Snider MT, Hill JD, et al. Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA. 1979;24220:2193-2196. [CrossRef] [PubMed]
 
Morris AH, Wallace CJ, Menlove RL, et al. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med. 1994;1492 Pt 1:295-305. [PubMed]
 
Taylor RW, Zimmerman JL, Dellinger RP, et al; Inhaled Nitric Oxide in ARDS Study Group Inhaled Nitric Oxide in ARDS Study Group Low-dose inhaled nitric oxide in patients with acute lung injury: a randomized controlled trial. JAMA. 2004;29113:1603-1609. [CrossRef] [PubMed]
 
Angus DC, Clermont G, Linde-Zwirble WT, et al; NO-06 Investigators NO-06 Investigators Healthcare costs and long-term outcomes after acute respiratory distress syndrome: a phase III trial of inhaled nitric oxide. Crit Care Med. 2006;3412:2883-2890. [CrossRef] [PubMed]
 
Gattinoni L, Tognoni G, Pesenti A, et al; Prone-Supine Study Group Prone-Supine Study Group Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med. 2001;3458:568-573. [CrossRef] [PubMed]
 
Guerin C, Gaillard S, Lemasson S, et al. Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA. 2004;29219:2379-2387. [CrossRef] [PubMed]
 
Derdak S, Mehta S, Stewart TE, et al; Multicenter Oscillatory Ventilation For Acute Respiratory Distress Syndrome Trial (MOAT) Study Investigators Multicenter Oscillatory Ventilation For Acute Respiratory Distress Syndrome Trial (MOAT) Study Investigators High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults: a randomized, controlled trial. Am J Respir Crit Care Med. 2002;1666:801-808. [CrossRef] [PubMed]
 
The Acute Respiratory Distress Syndrome NetworkThe Acute Respiratory Distress Syndrome Network Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;34218:1301-1308. [CrossRef] [PubMed]
 

Figures

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References

Miller RR III, Markewitz BA, Rolfs RT, et al. Clinical findings and demographic factors associated with ICU admission in Utah due to novel 2009 influenza A(H1N1) infection. Chest. 2010;1374:752-758. [CrossRef] [PubMed]
 
Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza InvestigatorsAustralia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza InvestigatorsDavies A, Jones D, Bailey M, et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA. 2009;30217:1888-1895. [CrossRef] [PubMed]
 
Zapol WM, Snider MT, Hill JD, et al. Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA. 1979;24220:2193-2196. [CrossRef] [PubMed]
 
Morris AH, Wallace CJ, Menlove RL, et al. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med. 1994;1492 Pt 1:295-305. [PubMed]
 
Taylor RW, Zimmerman JL, Dellinger RP, et al; Inhaled Nitric Oxide in ARDS Study Group Inhaled Nitric Oxide in ARDS Study Group Low-dose inhaled nitric oxide in patients with acute lung injury: a randomized controlled trial. JAMA. 2004;29113:1603-1609. [CrossRef] [PubMed]
 
Angus DC, Clermont G, Linde-Zwirble WT, et al; NO-06 Investigators NO-06 Investigators Healthcare costs and long-term outcomes after acute respiratory distress syndrome: a phase III trial of inhaled nitric oxide. Crit Care Med. 2006;3412:2883-2890. [CrossRef] [PubMed]
 
Gattinoni L, Tognoni G, Pesenti A, et al; Prone-Supine Study Group Prone-Supine Study Group Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med. 2001;3458:568-573. [CrossRef] [PubMed]
 
Guerin C, Gaillard S, Lemasson S, et al. Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA. 2004;29219:2379-2387. [CrossRef] [PubMed]
 
Derdak S, Mehta S, Stewart TE, et al; Multicenter Oscillatory Ventilation For Acute Respiratory Distress Syndrome Trial (MOAT) Study Investigators Multicenter Oscillatory Ventilation For Acute Respiratory Distress Syndrome Trial (MOAT) Study Investigators High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults: a randomized, controlled trial. Am J Respir Crit Care Med. 2002;1666:801-808. [CrossRef] [PubMed]
 
The Acute Respiratory Distress Syndrome NetworkThe Acute Respiratory Distress Syndrome Network Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;34218:1301-1308. [CrossRef] [PubMed]
 
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