Abstract
Background: NIV was not recommended for patients with influenza A H1N1 virus pneumonia complicated by ALI or acute ARDS,because, although it could temporarily improve oxygenation, it does not necessarily change the natural disease course.In this regard several authors have reported high rates of NIV failure in pandemic influenza A H1N1 pneumonia.However, other authors have recently reported some cases demonstrating the effectiveness of NIV in ARDS/ALI related to H1N1 pneumonia.
Aim and methods: The objective of this study is to describe the clinical characteristics of patients with diagnosis of Influenza A H1N1 pneumonia with ARDS/ALI with whom NIV has been effective.75 patients affected by Influenza A H1N1 pneumonia were admitted to our Hospitals: among them,29 patients presented ARDS/ALI;5 patients were admitted to ICU, and 24 underwent NIV and admitted to RICU.
Results: NIV failed in 3 of the 24 patients, but in 21 had a good outcome.
None of the patients treated with NIV died.
The duration of NIV was 5.0±1.9 days and the hospital stay 11.2±4.0 days. The average P/F ratio at admission was 184.6±29.2 and SAPSII was17.8±2.6; the average P/F ratio after 1 h of NIV was 239.1±42.3. No patient had multiorgan failure.
Discussion: In our study NIV had a success in 21 of the 24 patients (87.5%) and this the higher rate of success described in the literature: in our opinion the reasons explaining the results could be the choice of the patients to be treated with ALI and mild ARDS (P/F ≥ 150), and the strict following of the predictors of success for NIV as SAPSII ≤ 34 and P/F after 1 hour of NIV ≤175.
Clinicians should be aware of pulmonary complications of influenza A H1N1 and strictly select the patients to undergo niv: perhaps, can we give niv a chance?
- © 2011 ERS